Applying the Evidence: Morning Sessions

>>Because while
cueing people is H e important, we also
need to look around the corner to begin
the difficult process that’s head of us of
building communities of recovery, where we
take people where they are. That includes
everyone involved in the policy process who
might not be where they are today, that
we and while that is emphasized to people
during treatment and during recovery, what
we haven’t done is emphasize the
importance of institutional change. And that means each
and every one of our systems and
institutions have to change if we’re going
to build communities of recovery going
forward. That can begin with
the basics of the language that we use
to describe substance use disorders and
those with substance use disorders, and as
well as our systems such as our criminal
justice systems and our child welfare
systems, funding systems and the laws
underpinning all of our drug
policies. Each and every one of
these systems has to be subject to change, and we
can’t be afraid to look at our systems
and say: What do I need to do here
differently? So as we look at each topic
that we’ll discuss today, we should
ask ourselves: What are the institutional
changes that are required? Are these changes happening, and what
will it take to move faster and bring
about the change that’s needed as we
seek to move from rescue to recovery? So as part of that change and
to start the conversation, the
first presentation we’ll have this
morning is with the Hoya DOPE project. These are medical students at journal
town who are providing naloxone
training, naloxone kits across
the city. They’ve been
incredible enthusiastic
partners that we really have
enjoyed working with over the last couple
of months. So the first step
we’re going to take it inviting them up to
do the — I’m not sure where they
are — to do the naloxone training. And then — there there are — then
we’ll have our first panel. I will be back
after they are done, and
presenting. There will be naloxone available
also for you to take home. So I would ask
each of you to come up. Thanks. [APPLAUSE]>>Good morning,
everyone. We’re thrilled to be here
at volunteers from the Hoya Drug
Overdose Prevention and Education, also known
as The Hoya DOPE project. the aim is twofold. One, to contribute to the
large effort here in DC to address the
opioid crisis, as well as preparing future
physicians to be able to take care
of patients in the future with opioid
use disorder. And basic we do that
by training medical students to go out
into the community to provide education
and information to DC community
members who are at highest risk of
experienceing or witnessing an opiate
overdose, about how to recognize
the signs of an overdose, as well
as how to safely intervene with the
life-saving opioid antagonist
medication, naloxone, also known as Narcan. Our role today is to also share that
information that we go out into the
community to do. I’ll talk briefly a little
bit more about a couple of our
partnerships and then we’ll dive into
the bulk of the training. So we’re thrilled
that many of our volunteers
also come from The Hoya clinic, which
is a Georgetown free student-run
clinic, recently reopened after moving
from the DC general shelter to
triumph shelter in the local community. And we’re also very grateful to the
DC department of health and the
mayoral campaign, live-long DC, for
their collaboration and generosity in
providing naloxone for us to be able
to distribute every time we go out into
the community and provide this
informational session, they’re also
sponsoring the naloxone that we’ll be able
to give out today. We encourage you
all to come see us during the break
time at a table outside to pick
up a kit, ask any questions that
you may have. We’re available. Lastly, we’re
constantly looking for
opportunities to expand how we can contribute
to the hue mungous effort here
in DC to address the opioid crisis,
as well as how we can prepare ourselves
as future medical professionals
to be in the best position to
take care of these unique patients. And we’re really
proud of the Georgetown University school of medicine
for their most recent addition
to the curriculum, starting with the
class of 2021, of incorporateing
the buprenorphine prescribeing training
into that curriculum [CHEERING
& APPLAUSE] The last thing I want
to draw your attention as well
to our email address that’s up on the
screen here. We encourage you all
to reach out to us if you have any
questions about the content of the
presentation, if you’d like to hear
more about our work, if you’re interested
in discussing training out in the
community with any organizations that
you may be a part of or if you just
have ideas for ongoing projects. We’re really eager to
expand what we can provide and would love
to collaborate with any one of you. So with that,
I’ll pass it along.>>So when opioids
get into the body, we appointed
to receptors throughout, including
in the brain and brainstem. They attach
to receptors on nerve cells and
they decrease the sensation of pain. They also ruse anxiety and create
a sensation of euphoria. What they also do is importantly bind
to a point in the brainstem that’s
responsible for regulating
breatheing. What we do day to day is not really
think so much actively about our
breathing rate, so we rely pretty
heavily on our brainstem to produce
signals for us to maintain our regular
breathing rate. When we have foreign
substance substances in there
that interfere with that signaling,
it can be dangerous. So when we
have foreign substance substances
in there like opioids, we can
have things that decrease that drive
to breathe. When we see people that
have opioids in their systems, the
symptoms of being really high include
feelings of sedation, euphoria,
reduced anxiety and you see things
like relaxed muscles, slow speech,
slurred speech, they might be sleepy,
they’ll respond to estimation but
at greater levels, so pain estimation
might be — they might be responsible
to it, responding to stimuli at
a higher level. But over time, as you
continue to use the substance, tolerance
develops, so you need more and
more of the same substance to elicit
the same response. That can be
dangerous when you’re thinking about
opioids that operate at a center that
decreases your drive to breathe. So when you have
an overdose and you’re using more
and more of the same substance,
you’ll have decreaseed respiration that
manifests as things like a deep snoring,
death rattle, so a decrease decreased
expiration, infrequent or
no breathing. They might not be
breathing at all. Pale skin, clammy skin,
sweaty skin. A heavy nod. They might not
respond to to stimulation
anymore. A slowed heart rate,
decreaseed respiratory output, decreaseed
out put from the brain. Overall, what’s
lethal about opioid overdoses
is ultimately it decreases the drive
to breathe from the brainstem,
so you will stop breathing
ultimately.>>Now we’re going to cover how
naloxone works and just for reference
as Erica mentioned, Narcan is the brand
name for naloxone, so same substance
there. Naloxone is an opioid antagonist
and so what that means is when
naloxone gets on to the receptor that the
opioid is sitting on, it knocks it
off right away, and so it essentially
reverses the high that the patient
is experienceing. That’s really
useful in opioid overdose setting. So that is how we treat a patient
with an opioid overdose. And so it
takes two to three minutes to
exert its effect. Really quickly you
could expect the patient to sort of
sit up, be alert, maybe even a little
bit agitated as well. So that will
happen very quickly. An important
point to note is that it only works
for about 30 to 90 minutes and an
opioid can last in the body for
much longer. Even if the patient looks alert
and very active, you still need
to have them seek medical attention. So calling 911 is still very important
and having them come to medical
attention so that physicians can
watch as they run through the high and
make sure they’re not going to slip
back into a high once the Narcan or
naloxone wears off. So it’s not a
substitute for emergency care.>>With that
introduction, we’re going to go through
the actual steps about how to
administer naloxone or Narcan. The first thing
to do when you notice someone
who might be overdoseed from
opioids is to assess the responseiveness. Some of the ways you can do that is
doing the sternal rub, so placing
your fist in the middle of the chest
and rubbing rubbing down. If they respond
to that you might observe
them a little longer, but if they
don’t respond that can indicate they
are experienceing an overdose. You can also
shake their toe if you don’t
feel comfortable pressing on their
sternum right away. The best way to
elicit whether someone is responseive is
by the sternal rub. So assess for the
responseiveness, and also their breathing,
to see if their chest is rising,
the rate at which it’s rising is
important as well. Then the next step
would be to call 911 or have someone
around you call 911. As Emily mentioned,
naloxone is effective at
temporarily reverse reversing on
overdose but not a substitute for
emergency care. It’s really important
to get people into that setting where
they can be observed and treated
with — their high or overdose will
be observed for a longer period of
time so we can make sure they get the
medical attention they need from
thereon. So the next step would be to
perform rescue breathing to deliver
some oxygen if you feel comfortable. That would involve tilting
their chin back to deliver breaths mouth
to mouth and to observe if their
chest rises. That is an indicator that
the breath has gone in. But the most
important thing to do if someone is
experienceing an overdose is to
administer naloxone or Narcan. The kits we’re
going to hand out have these steps
outlined, so you don’t have to
memorize them right now. The way you
administer naloxone is to place a person on
their back with their head tilted
back to expose their nostrils. So you would
insert the full nozzle into
the nose and spray the entire dosage
into one nostril. You don’t divide
it between the two nostrils. You spray it
into one. As Emily mentioned
again, it only works for 30 to 90 minutes,
so it is important to get
them to care. But it does take two
to three minutes to work. After you administer
that first dose, observe them
for two to three minutes. If they start
to respond, that’s an indicator
that the dose has worked. If they don’t
respond after two to three minutes,
the kit has a second dose, so you
can go ahead and administer that
second dose of naloxone. And then once you’ve delivered the dose,
it’s important to place the person
in the recovery position because
they could be agitated, they could
experience some vomiting. The way you
do that is to place their hands
up by their cheeks and then cross one
leg over the other, as the picture is
demonstrating, and that can prevent them
from choking on their vomit if they
do vomit after coming out of
their overdose.>>That wraps
everything up. [APPLAUSE]>>We’re happy
to answer any questions briefly.>>There’s a lot of fentanyl out there,
which is more potent than
traditional heroin. My understanding is
you can acquire multiple doses of
naloxone in order. Could you say a few
more words about how you know when
to administer multiple doses and
how that works?>>Yeah, absolutely.>>If you can a question, if you
could go to the mic, that would be great,
because it’s streamed live.>>The question was about the increasing
availability of fentanyl and whether
or not the person who’s using opiates
on the street is aware if they’re
using fentanyl or not, which is a
much more potent opioid and often
will require more doses of naloxone
in order to reverse the opioid overdose. So this is exactly why the
kits that are now standard that are
being passed out all have two doses within
the kit, because we are seeing that
individuals may require two doses
to overcome the amount of opioid
that is in their system. The way — the
best way to know whether or not
someone needs that second dose is to
administer the first dose. We expect that
naloxone should kick in within two
to three minutes. So we suggest that
you just stick around, observe
that person for a couple of minutes,
see if their breathing starts
to become a little bit deeper, if they
are starting to wake up a little
bit more, becoming more responseive. As Rita mentioned, they might also
experience symptoms of kind of sickness,
of acute opioid withdrawal, like
nausea, headache. That is not
uncommon. But seeing that is an indication
that the first dose is working. If you’re not
seeing much change after a couple
of minutes, the recommendation is
to administer that second dose, because
that may exactly be what’s going on. The great thing about naloxone is
that if there is an instance where you
administer a couple of doses of naloxone
and the person does not have opioids
in their system, there’s minimal risk
of giving that to someone. That’s why it’s
a very safe medication and we
err on the side of giving the medication
when there’s a suspicion that
there’s an opioid overdose versus
withholding that treatment, given
that it is life-saving and the
risk is minimal. Great. We’ll be available
— oh, sorry.>>My name is
margarita. I have a question
about the rescue breathing. How long do
you recommend performing that
before administering the naloxone? Thank you.>>So initially when
naloxone came out, the rescue breathing was
a formal part of the administration
process. That subsequently has
been changed to it being an optional
component. The rationale for giving
rescue breathing is to help increase
the oxygen level in the person’s body,
assuming they have stopped
breathing or at least significantly reduced
their breathing in the overdose
situation. So there isn’t a formal kind
of recommended amount of time that
you would do that. Really, if you
administer a couple of breaths and then
quickly go to the naloxone, or even
just jump to the naloxone without
doing the rescue breathing, there
hasn’t been shown to be significant
difference in outcomes as far as whether
or not rescue breathing is
administered or not.>>Good morning, ladies
and gentlemen. My name is Lipi. I’m a physician. I’m so thankful
to all of you for sharing this
life-saving information. I didn’t learn
any of this during medical school, so
I’m proud of you for learning this
and then teaching the public. You’re making a difference. Does Georgetown
medical school have a
curriculum teaching addiction? Do you know if any of their residency
programs are teaching either their internal
programs are also teaching
addiction? Thank you very much.>>The biggest
thing I know as far as Georgetown
and I’ll open it up to you too, because
you may know better than myself as
well, the addition of the buprenorphine
training was a really large push within the medical school to
address particularly opioid use disorder. There are additional
opportunities within the couple of years
to expose medical students to addiction
as well. I remember in my —
in our first or second year, we
had a panel of addiction experts
as well as a couple of patients who are
in recovery who came to speak about
their experiences. Then we were all
required as part of our courses to attend
an AA or NA meeting to get
that exposure. So there’s certainly
been efforts to include that. Do you guys have anything else
to add?>>I believe there’s also a week
— we are second year students and
Erica is a fourth year student. I believe there’s a week between the
fruition from second to third year
where we have a week focused on opioid
use and I believe they cover some of
those additional topics during that
time as well. I’m not sure exactly
of the content. And the residencies,
I’m not sure on that as well. [APPLAUSE]>>Thank you so much. As I said, there will
be naloxone available outside. We appreciate
the medical students coming
and sharing their interest in
this issue. At the law school, we are
working to build partnerships with
the medical center. We’re actually going
to have a medical student who will be
working with us at the Law Center to
inform the work that we do on opioid
policies. There is much more work that
needs to be done in the medical
center — and the center acknowledges
the work they have done. I want to acknowledge
and commend them for
the work they have done and we look
forward to working with them on further
partnerships. Next up is our
fireside chat with three folks
I have great administration for. One is Michael Botticelli, who is
currently with the Grayken Center for
Addiction at the Boston Medical
Center, who also serveed in the Obama
administration as the director of
national drug control policy. I had the pleasure
of working with Michael for
a number of years. And then Tracie
Gardner, who is the vice-president of
policy advocacy at the Legal Action
Center. And the Honourable Stephen
Williams, the mayor of Huntington,
West Virginia. We asked them to come
today not only because they’re
great friends and allies but also
because they have an incredible
perspective to start to be the second speakers
for the day to kick off and again
to look beyond — around the corner
as to where they’ve been and what’s
coming next. Again, to move us from
rescue to recovery. I’d ask the three
of you to come up and be seated. Thank you. [APPLAUSE]>>Thank you, Regina,
for that introduction. As a point of fact, I carry my naloxone
with me wherever I go. We make it standard
practice at Boston Medical Center
to distribute naloxone. Really an honor
to be here today among many
friends and colleagues who have
been doing this work for a
long time. I thought I’d say a couple of
framing comments and remarks and then
have a conversation with two folks who
I’ve known for a long time who have
been engaged with this work and
have interesting perspectives. As I was thinking
about comments today, it
occurred to me that it’s really been
about 20 years that we’ve been dealing
with this epidemic. It started I think
this modern epidemic in the early
2000s with the dramatic
overprescribeing of prescription pain
medication and since that time we’ve
lost over 500,000 people in the
United States, staggering numbers
we have, and we know families and
communities have been devastated
by this. We’ve also seen huge increases
in people who have viral hepatitis,
endocarditis and outbreaks of HIV
throughout the country, threatening
to reroad decades of progress in our
fight against HIV. We also know that
economic costs of this epidemic have
been enormous. There is probably
no sector of government, of
business or of society that hasn’t been
impacted by this. I think we also have
come to understand that the causes of
this epidemic and quite honestly many
health issues are not just about the
specific drivers of the opioid epidemic
but are rooted in stigma and
discrimination, poverty, raceism, trauma,
lack of vocational and educational
opportunities and social isolation,
just to name a few. And we also have
to acknowledge that many of us have
been doing work in other arenas where
we’ve had other stigmatized epidemics
and people that can provide a road
map as we go forward. We have to
acknowledge that many of our
communities of color have been impacted by
this epidemic for a long time. When our response
to this was less therapeutic
and much more punitive. But to move
us to this theme of the
conference, we do know that some parts of
this country are making progress,
largely driven by people’s increased
access to treatment as a function of
the affordable care act and Medicaid
expansion, by the expansion of harm
reduction services such as naloxone
distribution and access to sterile
syringe programs, a retreat from arrest
and incarceration and active support
from many within the law enforcement
community. We’ve seen a much more
visible and vocal recovery community
and people willing to talk much more
openly and honestly about how this impact
has affected them. But to pivot
to the theme of this conference, I
have often invoked a phrase that the
director for the national institute
of drug abuse talked about as our
response to this epidemic, and it
really is the fact this we do know what
to do here, and our main function
and the two biggest barriers are
resources and will, right? So part of what
I think we’re here today to discuss
is how do we move and implement
all of those things we know to be
effective with a sense of urgency where
we can make more significant
progress? Even if my home state of
Massachusetts, a state that has made some
progress against opioid overdoses, we have
cities that are still seeing
significant increases in overdose death. So we also understand the importance of
how do we drive some of the work we’re
doing at the local level. With that, it
gives me great pleasure to be with
two folks who never have a shortage
of things to say. [LAUGHTER] Which
is wonderful. So I have an easy
job at moderating today. I want to
follow up on something that Regina
talked about. Many of us have been
doing this work for a long time
across not only this epidemic but
other epidemics. I want to start with what
have we learned synovwhere have
we made progress? I think all of us
understand it hasn’t been urgent or
widespread enough, but where have we made
progress in terms of how we have
approached this epidemic? Tracie, I’ll
ask you to start.>>Where we’ve
made progress. I think there’s
a greater understanding of
addiction as a health issue. Mind you, I
didn’t say a disease. It’s a health
issue and it’s been treated outside
of the health system or what we
understand to be the health system, in
a way that has put us behind. So we can’t
talk about where we are with
the overdose epidemic without
talking about raceism, because
even though the perception is that
we’re taking a different tack
because White people are affected, the
broken system, the inattention to the
system, what I would say medieval
thinking and approach to people
who use drugs, is what has created
this atmosphere. And so that othering
that happens, which is foundational in
raceism and the way that this country
has sought to address its original
sin, and how it has permeated every
single element of public policy that
we can think of. The more we
understand that this is — it’s an epidemic,
but it’s also a highlight of what
we’ve neglected. HIV was that, a
highlight of what we neglected. Everywhere that HIV emerges is usually
where a system has failed or we’ve
responded in a one one-off approach
or that we don’t bother to think
through the consequences of
policy responses made in the midst of
an emergency.>>Thanks, Tracie.>>Obviously I come from the public,
political sphere. What I’ve come to
learn, among other mayors, other
legislators, is that — let’s just state
it for what it is. Ignoring a problem
doesn’t make it go away away. A lot of communities
that you were referenceing
that are still starting to see the
overdoses rising were thinking: We
can’t talk about this. Sometimes it’s:
We don’t talk about this in polite
conversation. Well, frankly, if
we don’t talk about it it, how is that
being polite? The reality is that
if I have someone right next to me
that is dying, I’m not going to turn
my head and they’re not going to die. So what we’ve come to understand, and
what Regina was saying, is to shift
from saving people, to restoring
people towards recovery. This has been an interesting he if
I have epiphany for me of late. It’s been sitting
right there in front of
me all of this time. Mike, you remember
very well in August of 2016 fentanyl
arrived in hundred Huntington one
afternoon we had 26 overdoses in a four
four-hour period. Two people died
because they shot up alone, but we had
24 people who lived because we had
naloxone training for all our first
responders. I’ll never forget, right after
that happened, we were in could have
goneton Kentucky and you came up
to me and put your hands on my shoulders
and said: This is what we’re here to do,
so save people’s lives. That was a shift that
we made, because at first communities were
saying arrest them. Just arrest them. And we arrested
200 people in a 90-day period
and it continued ongoing. So we thought
we’ve got to save these people’s
lives. The problem was of those
24 people who lived, not one person
was referred to treatment, not one. And it’s taken, sadly, this long
for this idiot to kind of catch up. But I came to understand — it
just hit me just a couple of months ago,
we save someone from dying, we didn’t
save their life. When they go to
recovery and advance through recovery,
then we can say we’re saving
their lives. That’s become very, very
personal for me, that we can’t just
save somebody from dying and
say: Done. That just doesn’t work. So where we’ve
come is that cities across
America, through the leadership of
mayors and others locally, are
realizeing this is something that we
have to acknowledge, and in acknowledgeing
it, say it for what it is. Say it for
what it is. There’s an ancient
maxim, if you name it, you can own it. So say it for what it is. There are a
lot of folks in Huntington that
would just as soon I had never said
it, because Huntington, sadly,
has a stain on the name, because people
now try to say that Huntington is
the epicenter of the heroin epidemic,
and I hear that from a lot of other
communities. They say that, and that
just aggravates the living dog something
out of me. [LAUGHTER] You
thought I was going to say it. [LAUGHTER] What we’ve come to
realize, and this is where the
leadership has to occur, is that we’re not
the epicenter of the epidemic; we’re the
epi epicenter of the solution to
the epidemic. And then that starts
to translate to all sorts of other
things, because it’s not just heroin;
it’s also fentanyl, it’s Meth it’s
addiction. It’s not just an opioid
epidemic.>>Absolutely.>>For those folks familiar with the
12-step world, it’s oddly coincidental
that acceptance is the first step
on the path to recovery. So I think
you say that exists.>>Cities are in
recovery too. I keep saying
to folks in our community: There
are individuals who are in recovery
and our city is in recovery. I’m seeing that
as a very positive sign as to
we’re not looking as to what’s happened
in the past. It’s what we have
occurring for us in front of us and
in the future.>>I also want to point
out I remember that day vividly when
we heard about the fentanyl outbreak
and how frustrating it was at the federal
policy level to basically have
two-year-old data systems in terms of
understanding not only — and I often
say it’s hard to look around the
corner when all you have is a rear
view mirror. Part of not discussion today
but I think part of our overall
response to the opioid epidemic is how do
we improve our data gathering systems.>>Someone throwing a two innings later.>>It’s important that we unpack, and
I don’t want to undermine the whole
point of the conference, but
recovery needs to be unpacked, right? Our insistence that recovery is
abstinence is also what’s killing people. Recovery is whatever you say it is,
whatever you mean it is that will save
your life. You and I have come up where
harm reduction was this dirty word
and people — harm reduction is about
love and it’s about caring and it’s about
valuing the life of a person who
uses drugs. We’re barely out of the
realm of thinking where people think
that the best antidote to active
addiction is that someone dies, because
they’re thought to never recover,
to never stop. And our understanding
of what it means for people who use drugs
problematically, and that’s the
other thing. It’s just like alcoholism. The alcoholics, the problematic
alcoholics, make up a small percentage
of the people who actually drink, and
the people who are struggling with
substance use disorder are a small
percentage of the people who use drugs. Refusing to acknowledge sex and
drugs has gotten us into trouble over
and over again. So, right, name it,
be real about it, own it, and then
you can do an intervention. But if you
pretend that that’s not what’s
going on or, even worse, that those
other people around there having ”
“unsafe sex”,” those other people out
there using drugs, there are no others. It is you. It is happening. I think that’s one of the main lessons of
this generation of a drug epidemic,
is showing us there is no other.>>Let me follow up on that, because I
think it’s really important that —
we know there is this huge gap
in terms of our understanding of what
is effective and promising, right? You just talked about harm reduction
programs being tremendously
effective. We know there are many, many things
that we can do, but there is this
huge gap between kind of what we know
to be effective and implementation,
right?>>It’s will, right?>>So one of the things that I’ve come
to understand and people have heard
me say this before, is that science and
data don’t drive public policy,
unfortunately, right? So how do we, from
your perspective, what are the other
levers at our disposal, if science
and evidence are not going to
move people to implementing all the
things we know to be effective, what
are the other tools at our disposal that
we can kind of move and kind of
apply what we know and enact what we
know with a greater sense of urgency? You could certainly talk at the national
level around some of the legal work. Mayor, you had the challenge of how
do I do this at a local level.>>And we were having
this conversation a little earlier. It’s what you said,
political will. What does political
will mean? Political will means
that the priority is articulated and
implemented in such a way that things
happen. I have never believed
there’s not enough money. There’s always
money. It’s always about
priorities and what informs what the
priority will be. Right now, we are
prioritizing people with opioids. We will have to prioritize people
who use stimulants. We will have to
prioritize — you know what I mean? And that is a huge mistake that we
should do a real deep full stop on. If we keep talking about opioids,
we’re already perpetuating a
duality of systems where if you can’t
be addressed by the three FD FDA approved
medications for opioid use disorder,
you’re out of luck, and that’s
rid can you ridiculous —
ridiculous ridiculous. The other element
I’ve seen is when the executive decides
it’s a priority, I don’t care if it’s
the county health official, but the
mayor, the governor or the president,
that’s when things happen. I love my
legislatures, but it’s really the
executive mandate that can make things
move.>>A committee has never solved
anything.>>A task force.>>I love my
legislators, state and federal. I have yet
to find them ever solve anything,
ever. [LAUGHTER] Whether my party
is in power or not, they don’t solve
things. In the Congress there’s
535. There’s one president. In a state
legislature, in West Virginia,
there’s 134. There’s one governor. In my city we have 11 council members. There’s one mayor. Who’s going to make
the decision? The mayor. A govern governor
maybe. And a president,
we’ll see. But the thing is that it gets down
to really at the local level level,
you know the difference between
major surgery and minor surgery. Minor is when you’re having it. Major surgery
is when I’m having it. [LAUGHTER]
It’s a major problem when it’s
in my backyard. When it’s
in my town. And folks — you’re
asking about the willing willingness
to step forward when it’s sitting there
right in front of them and just staring
at them. They just can’t look any
other way. Hell’s bells, that’s how
I ended up facing it. Again, I thought
it was a policeing problem. There was one morning when
I came in in. We had a raid on a house 500
grams of heroin had been delivered
to this house the evening before and
I was told we’re going to have a raid
at 8 a.m., asked me to come in to
observe that raid. We thought we
had a big score. After our SWAT team went
in, there was only 35 grams of heroin
left in the house. 465 grams had been
distributed, and I started doing some
research to figure out, well, how many
people is this affecting? One tenth of
a gram goes into a needle
for a hit. So that meant 4,650 hits were
being delivered. There were thousands
of people in my community then that
I saw the extent of the problem then. That’s when I realized: We have
to do something. If we were waiting on
others — people were coming
up to me. You’ve heard the story — saying:
Mayor, we’re losing our
neighborhood. Mayor, please, you have
to do something. Frankly, that’s
where, if this — whether it’s the
opioid epidemic or whatever else,
the epidemic of addiction is going
to be addressed when the decisions
are being made at the local level. It doesn’t necessarily have to
be a mayor mayor. It could be someone
in the community that’s standing
up and saying: Somebody needs to
do something, and that’s me. Now, who’s going
to stand by me on addressing
this? There are no lack of
resources.>>Absolutely not.>>There’s no lack
of resources.>>I never want
to hear it.>>Listen, in my office, what
I’ve said at the very first day
that I’ve been in office and the seven
years since, don’t ever come in
and say we don’t have the money. Money is tight everywhere. Get over it. That’s why I’ve hired you. Use your brain to
figure out how to get there. If you’re saying the
only way I’m going to do it is if we’re
going to have additional money,
then you’re not as smart as I thought
you were to begin with. And it’s amazing
where we have found — there are
resources hiding in plain sight in
every community. The people who are
sitting there, there are individuals
who are being repurposed, still
have the same jobs. I created our own
office of drug control policy. I saw what you were doing and thought:
I want to do that. And we created
our own. But I didn’t hire anybody new. I just reassigned them to do other
things things. And there are people
hiding in plain sight. There was one
lady that was sitting in our fire
department who was also a nurse working
in the emergency room. She was a captain
in the fire department. She had been
part of the fire department
for 20 years, not really active
in anything. She became a deputy chief. Now she’s the first fire chief, female
fire chief, in the history of the city,
in the history of the state. Jan Raider
was named one of the thetop 100
most influential people in the world. It’s not out there. Hells bells, she was
sitting right there in Huntington, West Virginia. It’s right there just waiting to be
called upon.>>But you made it happen. You made it happen.>>The community
made it happen.>>Well, the community
got in your face and said you
better do something. That’s part of
what we’re talking about. It sounds kind
of lame when people say what
you have to do is vote. But a lack of
civic engagement is also what has
gotten gotten here, because people don’t
give a crap. They that I it
doesn’t — that there will be no impact
if we tell Mayor Williams this is
happening, and nothing could be
further from the truth, right? Even if this day of social media, there
is nothing like the direct engagement
and really flying in the face
of the apathy that policy-makers
think is in the electorate. Elections —
I don’t want to talk about
national elections, but state and local
elections are the — the difference can
be a block or two. The other thing
I want to put out, because people
are like: What? You’re going to
be on a panel with someone from
West Virginia? How is that going to go? [LAUGHTER] No No, because the issues
are the same. Anywhere you go, you
are going to find some of the same
kind of poor thinking, right? Anywhere you go, I’ll bet your ”
“mental hygiene” system is separate
from your health system. I bet that your
health system will and has up until
recently been sending or bringing
in law enforcement. We have siloed
in a way that is going to
really, really keep us sick, and so why
we have systems that deal with mental
health, that deal with substance
use disorder, that deal with physical
health? It’s the same person, but
we have different policy, different
systems, different funding. So unless there’s
enough funding funding
for mental health, somehow that will
take away from addiction. Some people
only have one issue, which is
rare, actually. There are few people
who have only one issue. So how do we
address the systemic fracture
in order to really — I know, the word”
holistic” isn’t right or is tired,
but unless we do that, it’s not
going to work. We learned that in HIV,
that we wanted to think it was just
about prevention, intervention. We were just going to talk about sex. But then things started growing. Well, they need to be housed, or we
need more primary care, or we need
to integrate. We need to co-locate. And we started building a whole
new health care system that started
in response to HIV. But yet we are
still in this place where folks
of color color, particularly “sexual
minorities” aren’t in the 2020
year of HIV as a chronic, manageable
disease. So again I warn that unless
we look more comprehensively we’re
going to create bifurcated systems
and it is going to go perpetuate the
the inequalities that already exist. One other thing: I don’t want to hear
anymore — these are all the things
Tracie doesn’t want to hear anymore
— social determineants of
health is a way of saying people have
messy lives and they can’t prioritize
health the way health wants to. My contention is that health
relinquished its responsibility to
address addiction. It relinquished it. It said we’re not going to deal with
those people, and allowed or relegated
people to the criminal justice
system which said: OK, we’ll deal with
it, but we’re going to do a crappy
job at it because we don’t have the
money that health has. Now we’re figureing
out these innovative models
of bringing together criminal justice
and health and looking at the
Medicaid law and saying really we’re not
treating people before they leave
prison and Israeli all of this stuff
we’re rethinking. There is plenty
of blame to spread around but there’s
also plenty of opportunity. Social determineants
of health is just people
— people who live real lives and
who have to prioritize their
health as well as other elements
of their lives.>>I will say, as
a large safety net institution, it’s
really interesting when your payment
and delivery system basically only
reimburses you for a thing that you do
when we thoroughly understand that
what drives poor health for our
patients at BMC are things like unstable
housing and history of trauma
in their communities and lack of access
to care and their immigration status,
are all issues that are important. So let me pivot to
that, because I think it’s important as we
start thinking around the corner. Those of us
who have been doing this work
— Tracie, you articulated one
of them, that this epidemic really
exacerbated and pointed to
long-standing structural issues that were
wrong with our system to begin with. You pointed to one of them, and that
was the lack of integration or
the siloing of addiction treatment,
one can say largely to a criminal
justice system but marginally to
a separate treatment system. You talked about the integration. If we’re going
to make enduring progress
on not just the opioid epidemic,
but we all see stimulants coming
around the corner, I want to ask you
either at the national level, mayor,
you’ve been talking about this at the
local level, what are the structural
things or what are the big things that
we need to make sure get addressed
in terms of those systemic issues if
we’re going to make some enduring
progress on not only the evolution of this
epidemic but kind of addressing this
as we go forward?>>I’ll say quickly
that some of it is happening, which is
we are — make no mistake that we are
also reaping the “rewards” of this
40-year war on drugs. We’ve established
whole systems that
basically have been influenced by that
enormous public policy. So some of it
is going to looking at where
the really systemic barriers are and
unpacking them. One of the issues
that we’re working on in the Legal Action
Center has to do with Medicaid is 55 years
old and there’s a Medicaid law that
keeps people who are incarcerated from
getting Medicaid coverage, and not
one person I’ve talked to around
this country — everyone has told
the tale of individuals leaving
the correctional setting, coming
back home, because they almost always
do, and having no health care, having
no Medicaid coverage when they’re
coming back out. Unless they hit
the lotto when they were inside, they
qualify and can be covered for
Medicaid. But we have this baked-in
dysfunction that says: We can’t let them
steal health care. So we have people
coming out without a safety net and
walking into death now with this overdose
epidemic. People are leaving the
correctional setting and overdoseing at
rates much higher than anywhere else. What is the fix? That we’re going
to build these new systems to create
and do inreach into jails? No, just remove the restriction for
this particular re-entry population,
simple, easy. Again, a president
could do it, executive order. A Congress could do it. But there needs
to be kind of cutting away of the
oh, but we can’t, the special interest,
the insurance companies, whatever. If it’s an epidemic, if people
are dying, then let’s approach
it that way. That’s an example of some of
the look at what we put into place in
40 years that does not work anymore,
the last 40 years, and get rid of it
or unpack it or repurpose it.>>That’s assuming we have a Medicaid
system that still covers people. [LAUGHTER] Mayor, you talked about
this before. How do you make enduring changes
in Huntington so that you have a
much more kind of resilient community,
not only in terms of moving from rescue
to recovery, as Regina talked about,
but in terms of kind of creating a
sense of community and vibrancy, so
you’re protected from the next potential
epidemic?>>When we first started
discussing, in this conversation — we
were talking about will, breaking
down silos. As I started talking
about different groups, I have no
background in any of this. I’m a finance guy. I was a stockbroker. To come in
to this, as I indicated at the
very beginning, I thought it was
a law enforcement problem. But as I came
to become more aware, everything
was siloed. The health department
was off on its own, the state was off
on their own. Behavioral health
programs off on their own own. Faith-based community was off on its own. Law enforcement was out just
arresting people. Within the prisons, when they
would come out, when a prisoner would
come out, they were right in that
system, but they came out and nothing
had been done to address any issues
of addiction. What we came to understand
is that we had to have everybody. You were there when — some of what
I was saying, is that I became just
very adamant, wherever I would
go to speak, that everybody had to
understand that everyone had
an assignment. Everyone had an assignment. And everybody — and once having
that assignment, people needed
to talk with one another. Collaboration led the partnerships. As you started to partner, you
created trust. It’s a very simple formula. Collaboration, partnerships and
trust equals hope. Hope. Hope isn’t a
strategy; it’s an out outcome. So I speak
in things in a very simplistic
way way, but when people were saying
somebody needs to do something, I’d
say look in the mirror. You have something
to add. And what’s been
absolutely fasci fascinating is that
now the medical school is talking
to the hospitals. [LAUGHTER] The
pharmacy school is talking to the
medical school. The health department
is talking to the police department. Right down the road from us, we had
created the first harm reduction
program in the state of West Virginia,
right down the road in our capital city
they came in and created a harm
reduction program, but no-one was talking
to one another. When they were
running into issues, then the harm
reduction program got shut down in
Charleston. We found a way, not perfect by
any means, but you have to be constantly
reviewing, evaluateing and
adjusting, constantly. So when our police
officers were encounter
encountering an increase in needle litter, they
brought the health department in, let’s
talk about this. And we’d go on a
raid and we’d call the medical director
and he’d come walking in to what
we were walking into and seeing all
the needles all around that were
coming from the syringe exchange
program. We made some adjustments. Now the medical director goes in and
there are Sharpie cans where the
sharps, the needles are, and he
can tell. Now when they’re bringing
the syringes or the needles back in for
an exchange, more are being brought
in than are actually being delivered. So I’ll butcher this, but when
a leader’s job is completed when the
aim is fulfilled, the people say ”
“look what we did for ourselves.” That’s
the key to leadership. What I’m most
frustrated with is that in 2017,
the president announced a state
of national health emergency regarding
the opioid epidemic. This is the greatest existential threat
facing our nation, period. Greater than
terrorism, greater than a wall. It involves foreign relations. It involves criminal justice
system. It involves the health
care system. It involves workforce
development. It involves the economy. It involves
everything, exactly what you
were saying. It is not all of these
things. It’s everything.>>Yeah, but
they hear it better when
you say it. [LAUGHTER]>>Let me follow
up on that. I think you talk quite
passionately that this has to be a
multi-sectoral response. Every part of our
community and every part needs to be
engaged here. So who’s been missing,
right right? Are there sectors, not
necessarily in Huntington but as
you travel around the country?>>There are in Huntington.>>Are there
sectors, and Tracie, you can
reflect on this — are there sectors that
you wish who are dramatically linked
to the table here and who haven’t
stepped forward in a meaningful way.>>We had this conversation when
we first met, the faith community has
stepped in, in a major way, in
Huntington. We have a quick response team. 24 to 72 hours, when we go to talk
to the person who has over overdosed
to try to help them get treatment, we
have the police officer, the EMT,
we have a recovery coach and we have
a pastor sitting there. Some people
are saying, “I don’t want to
talk about that religious stuff.”
That’s fine. Then the pastor is there
for the others. But that one day
when we had 24 people that — or 26 people
that overdosed and 24 people that
never made it to treatment, or
any attempt to treatment, now one
third of the people who were going to
— it’s still much lower than what we
want, but one third versus zero zero? The faith community has been — has
stepped up in a major way, but the faith
community also gets in the way. Talk about
bifurcated. There are some
that just say, “I really don’t care
what your faith tradition is. Just love one
another.” Compassion. Compassion. But we’re also seeing there’s
a level of compassion fatigue
when a community says, “Let them
die die,” that’s telling me we’re
a passionate community, but people
are so fed up. We have received
grants from the Bloomberg Foundation
and others to address compassion
fatigue among our first responders. We’ve talked an awful lot about
helping those who need to go to recovery. Good God, I have to take care of my
firefighters and my EMT workers and our
police officers officers, what they
see day in and day out, the level of
trauma that they’re experienceing. Again, this is the
greatest existential threat facing our nation.>>I just want
to say I don’t know if it’s who’s
missing, but it’s an element that’s
missing that we don’t like to talk
about, kind of bootstraps and
everybody.>>You have to have a pair of
boots if you’re going to bootstrap
it.>>We need need to use money to
incentivize or support people in being able
to do the right thing. A lot of this
is presumed out of the goodness of
their heart, the responsibility of
the public sector. We’re a capitalist
society. If we’re really capitalist,
people need to be paid. The example that
comes to mind, as you mentioned
Bloomberg, what you pay at the beginning
nets you so much more in terms
of a savings. Mayor Bloomberg when he
was mayor floated the idea of paying
people to eat way well or paying people
for these things that society
believes, no, you should just do on your own. If we paid individuals who use
drugs to get those syringes, there would
be no community syringes. There would
be no needle sticks. That idea, remember
back in the day when we
thought needle exchange is going
to encourage drug use and that did
not bear out. I would love to see
someone actually put their money where
their mouth is and put some money into
people’s pockets to incentivize them
to do the “right things.” I think
you would see radical changes.>>Interesting. We only have a
minute left. I’m saying that. I’m looking
at you, Mayor Williams.>>The legend
continues.>>Those of us who
have been doing health-related work
for a long time thoroughly understand
that you have a crisis, lots of
attention, lots of money, lots
of resources. We make a little bit of
progress and then all the attention and
all the urgency goes away, right? So in a very short couple of sentences,
for a very big issue, how do we
maintain a sense of urgency on this issue
so that we’re not just making
a little bit of progress?>>Why must
it be urgent versus we take a
completely different generational
mindset. I know it’s not accomplishment, we
won’t see it, but we have to stop
dwelling and working in the acute and
start doing more preventative and
start doing more that’s health
promotion. We would not be here if that were
the approach all along. So the closest
we’ve gotten to it or some elements
of ACA, I have to talk about my
president, but that is as close as we’ve
come and look how fraught that is. So I would like us to stop being in
urgency and to start having a mindset and
a policy approach to health promotion.>>Boldness has genius and
magic in it. Give permission for people
to be bold.>>Thank you.>>Two sentences.>>I want to thank
our panelists. You did good. Thank you,
everybody. [APPLAUSE]>>Thanks so much. That was really wonderful and sets
a lot of the tone for the day. A couple reminders reminders,
housekeeping things. We have a break now
until 10:30.. You’re on the next panel
we ask you to come back five minutes
early so you can get micked up. The coffee
break will be held where you
signed in. You can get all the way down
and take the elevators to the
fourth floor if you don’t want to
do the steps. The hashtag for today
is GU addiction policy, if you
are tweeting. And also lastly I want to
thank Business for Impact for helping
us with this event and also with this
wonderful venue. They have — this
is the business school. It’s awfully nice. We’re very happy
to be here. So we’ll see you back here at
10:30 to discuss medications to
treat opioid use disorder in
correctional institutions. Thanks.>>Again, just a
reminder: If you have questions, to
go to the mics. We’re in the center aisles
and I’m sure we’ll be put back
there at some point. Thank you
very much. Dr Lipi Roy.>>Good morning,
everyone. Thank you, Regina and the
entire team for putting this together
in this beautiful venue. I made a joke about how medical schools
never look as nice as business schools,
so it’s nice to be in a really
pretty facility. Can folks hear me
in the back? Excellent. So the alarming
number of overdose deaths driven mostly
by opioids has clearly become
a public health epidemic. This health
crisis has disproportionately
impacted incarcerated men and
women, among whom over 50 per cent
experience a substance use
disorder. And even though life-saving
medications exist, and egregiously
low number of correctional
facilities offer any type of evidence
evidence-based treatment. A couple of years
ago I was the former chief of addiction
medicine for New York City jails,
including the island, and among the many
lessons I learned, one of them was
if you weren’t traumatized before
you got there, you sure as heck will
be once you get there, no matter what
side of the bar you’re on, a
correction officer or somebody who is
actually behind bars. The other lesson
I learned quickly is that over 50 per
cent of the men and women there had some
type of substance use disorder and few of
them were receiving treatment, although I
will say the island is one of the few facilities that
offered evidence-based treatment, including
methadone, buprenorphine,
as well as mental health and substance
abuse counseling. All of you are
in for a treat for this morning’s panel,
titled Saving Lives: Access to
Medications to Treat Opioid Use Disorder
in Correctional Institutions
and Reentry. So I’m going to give — the
way this will be structured, I’ll
give a brief one intro to each of
the speakers. You can read about
their very impressive bios in your
handouts. Each speaker will have ten minutes
to his share their thoughts and
areas of expertise. First, to my left,
is sheriff Craig Apple. He’s been the sheriff
of Albany County since 2011,
previously a corrections officer
and investigateor. You can read
more in his bio. Elizabeth Connolly
is project director, Substance Use
Prevention and Treatment Initiative
for Pew Charitable Trusts. Next to Beth is Tara
Kunkel, senior policy adviser with the US
Department of Justice, Bureau of Justice
Assistance. Next to Tara is Mr Jeff
Locke program director, Homeland
Security and Public Safety Division. That’s a mouthful, Jeff, as a title. Holy cow. This coming from somebody
who also has the director of Addiction
and Public Policy Initiative
addiction. Last but not least is Mr
Michael White, director, Community
Programs, Community Medical
Services. We’ll start off with the
sheriff speaking.>>Good morning. As Dr Roy indicated I’m Craig Apple, from
Albany sheriffs, from Albany
New York. It’s always a pleasure to talk
about some of the great things
happening in our correctional
facility. A few years back we noticed a
drastic increase in opioid overdose
deaths, overdoses, and we needed to
do something. We needed to sit back and
figure out and come up with a new
game plan. To regress a little bit, Albany
has 1,040-bed correctional
facility, which is somewhat
disproportionately crazy when you look at the size
of our county. So we always had
the philosophy of lock up those who
are using drugs, throw them in jail
and let them sort it out. Obviously that
methodology has failed, so we
needed to come up with a new,
innovative way to try to change this and
keep people from coming back. We created
the sheriff’s heroin addiction
program, our SHARP program. We started
to interview inmates coming in
and asked them if they were addicted,
used opioids, and if we want a shot
at a clean, healthy and productive life. We had treatment advisers come
in, peer to peer counseling and put
roughly 400 people through that
to date. We use a recidivism rate of
roughly 14 to 16 per cent. It varies day
to day, but relatively a third
of what most count correctional
facilities’ recidivism rate. We used what I
thought was the new miracle drug,
and it never took off. It kind of was
stuck in the mud. So over the course
of the years I was beaten down with
emails from some of our treatment
providers to get involved in medically
assisted treatment. We started
to dispense naloxone, beaut
beaut, methadone, and we’ve put roughly
300 people through our treatment to
date, 40 in the jail currently with a
recidivism rate of 6 per cent. There are a
few misnomers out here and I’ll
try to talk fast and open it up for
questions because this program we’ve
been able — first of all with the
assistance of our New York state Oasis,
Bob Kent has been a blessing to
our program to reappropriate funds
to keep this thing going and we’ve spent
roughly $65,000. If you look at
$65,000 in drugs to keep 253 people out
of jail and clean compared to $66,000
per head actual cost of
incarceration, it’s really a no-brainer. We’ve proven
this concept in New York. We’re hoping
it spreads. I think we were the
first outside of the island to
establish it and now I know there are other
counties, there’s legislation, there’s
a lot of things happening in New York
to hopefully get medically assisted
treatment out there. I was against
it at first, in totally transparency. I just had a hard
time accepting this in a correctional
facility, knowing that I always had Suboxone
smuggled in the facility, methadone
and I’ve seen people overdose
on it it. If somebody knows they have it,
they could get — whatever the
case may be. But fortunately, again
through basically being worn down
with some of the advocates in the
community we switched to it. Honestly Honestly,
I’m kind of sorry that I didn’t
do it earlier and I wonder how many
more lives we could have changed if we
had done a humane approach with the
medically assisted treatment. It’s up and running. I thank Oasi Oasis
every day for it and a lot of other
providers, Catholic charities who does
wonderful work with us. We’ve been able
to turn that facility into a
really great facility, releaseing inmates
that can go out and live the life we
live every day and take for granted. We’ve even involved, we’ve
just opened up a homeless shelter in
the jail with some of the space
we have. In Inmates getting out that
have nowhere to go, fighting addiction,
and lost everything they
have, we can bring them to the other
side of the jail where they have their
own room and we can work with them
on getting job skills training,
mental health counseling, still
in recovery, whatever the case
may be, we have programs up
and running. There’s been some really good
things happening up there [APPLAUSE]>>Thank you, sheriff. That was really remarkable
the work that’s happening in Albany. County. I think Beth is next.>>Thank you so much. Thank you to the
ONeill Institute for hosting this
great day. We’re really excited to be here. I’m with Pew Charitable Trusts,
and we’re a non-partisan research
and policy organization, through
partnerships with the Bloomberg
philanthropiece we’re able to go
into states and provide technical
assistance around reduceing overdose
deaths due to the opioid epidemic. I was thinking about some of the data
that’s out there definitely about,
as Dr Roy mentioned, that people involved
in the criminal justice system are so disproportionately
impacted. One of the statistics you
may have heard is that in 2017, 47,000
people died of an opioid overdose. I was trying to put that in context
in my head. It seemed timely as watching
the world series, and I heard that the
capacity and the attendance at one
of the world series games was 46,000. As you looked across
the stadium, as I was watching on TV,
because I certainly wasn’t there, I
thought you’d have to put a thousand more
people in the infield and all of those
people died in one year. It was staggering
to me when I saw those people
sitting there, how much that hit home. Thank you, sheriff, for your
great intro, because you are a convert
to medication for addiction treatment,
which is fantastic. Some of the
work we’re doing at Pew is
trying to bring people who will have been
converted and/or understanding what
medications can do for people. Someone like
you is so important to
our work. I want to give you a bit of
information about a particular project
we’re working on because it’s really
at the starting point and so we’re
very hopeful, but really about how
we’re going through this process. Full disclosure: I am the former
commissioner of human services for the
state of New Jersey and I’m going to
talk about New Jersey, you but it’s
not necessarily because of that. A couple of years ago New Jersey
started to bring substance use
treatment into the prison system. So the whole state prison system was
bringing medications into the system for
people with opioid use disorder. And this was really great. We were very
proud of it. As the years have
passed now now, what the prison system
is seeing is that as people go through
the judicial process into the jails,
they’re only getting a handful of people
that have any substance use
treatment when they actually get into
the state prison system. Because if you’re
familiar, pretty much people
do not go from being arrested
directly into a state prison system. They have an interim step that they’re
often in a county jail system system. So we’ve been asked to go into
New Jersey and help to bring medications
into the county jail systems. And there’s 19 in New Jersey and they’re
very different different. Some are very
open and are actually using
medications in the system, and others
are trying to figure it out, not
understanding why the importance, not
understanding the importance of three
medications and not just one
medication that’s readily or easily available
to many systems. So this is sort
of our effort right now. We’re looking
at it across a system. So we think about
treatment, we think about a
continuum of care in the community. But really we can translate that into
a continuum of care in the judicial
system. So where are people
coming into the system and what is the care
they’re getting? So that as they
progress through the criminal justice
system, either from jail back into the
community or from jail to prison
to back into the community, what are
those pieces that need to be in place
to make sure people can be
successful and receive the treatment
they need? Some of the things we’re working
on, number one, is access to
treatment within each facility. What will that
look like for each facility? If you think about your own counties,
the counties in New York, in the states
where you all come from, different
sized jails, a complement of staff
staff, how is it we can help to
formulate what kinds of medical assessments,
treatments, will be needed in order
to address it, no matter what the size
of the population is in each jail. From there, what protocols are needed
to be instilled into the system so
that medications can be administered
appropriately? One of the things
New Jersey realized when they did this
in their prison system, as Michael
referred to earlier, the stigma
that was really involved. It was really
per pervasive across the staff
in the system. So not understanding
what medications were, not really
understanding what substance use
disorder is a chronic brain disease and
needs to be treated like diabetes or
like hypertension. So education of
the staff became really important
because it wouldn’t be successful at
the state prison system if folks
were not really understanding what
they were doing and why they were
doing it and the importance of doing
what they were doing. So this education
component is going to be another
key portion of what we bring to
the county jail system. In New Jersey
they have bail reform. One of the first
states to actually implement,
fully implement bail reform, which
means that, for them, 91 per cent
of the folks entering the jail
system are there for 48 hours or less. So how do we structure a program
so that folks that are coming in and
leaving so quickly back into the
community are either starting treatment
or being connected if they’re going
out very quickly? And this, talking
about our continuum of care, means in
educating not only the folks inside
about moving people through quickly but
also how are you making these
connections back into the community? Again, going back to stigma. We can have a lot of providers in the
community, but there’s also stigma
in the provider community. Some folks are
not ready, willing or able
to work with folks coming from the
criminal justice system, and how do
we educate and work with them? So working with the state’s behavioral
health system, the behavioral health
department, in ensure that there
are providers out there ready when
folks are coming back into the
community, especially as they so rapidly turn. Another critical piece in moving
back into the community is
Medicaid. So a payor, connecting folks
with Medicaid, ensuring — and is
one of the states that does not stop
Medicaid when they enter. It’s put on hold
so folks can transition easily
back on to their Medicaid benefit
in order to receive treatment. The last part of our project, which we’re
excited about and hopefully next year
ONeill Institute does this again and
I can talk about the data. Johns Hopkins
University is evaluateing
our project. They started with us from day
one, creating great baseline data. Hopefully
next year we can talk about
some of the great things we’re seeing. I’ll turn it over.>>Thanks, Beth. Pew Charitable Trusts has been doing
excellent work. I cite their reports
and their data all the time. So thank you,
Beth, for sharing that. Tara is next. Looking forward to it.>>Thank you, Dr Roy. My name is Tara
Kunkel, I’m a Senior Associate Dean
at the Bureau of Justice Assistance. If you’re not familiar with BJA,
we’re one of the primary funders
for sheriffs, law enforcement and
all parts of the criminal justice
system. I over oversee the
comprehensive opioid abuse program, which
is a major grant program. This year we
awarded $187 million in funding
and a great deal of that fund funding
went to support medication-assisted
treatment. I’m going to borrow
Michael’s phrase of will and resources
and start there. I want to say —
start with will. Over the three years of
administering the grant program, what
I have observed in my role is a change
in interest on the parts of jail
administrateors and introducing MAT
in particularly all three forms of MAT
into their jails. Last year was just
an amazing year in terms of interest
and applications and requests for
technical assistance in this area. I think that’s
in part, and I really have
to acknowledge the stakeholder
associations that work with sheriffs in
stepping up and offering more
educational programming in this area,
providing more information about
potential lawsuits, sharing information
about technical assistance. I really want to acknowledge and
recognize the national sheriff’s sheriff’s
association for all the work they’re
doing to make information about
MAT accessible to their stakeholder. States are passing legislation, as you
know, requiring MAT in jails. I think that’s also contributing to
the interest. And I think frankly
sheriffs are making this a priority. They are making
this a decision in their
budget, a decision philosoph
philosophically, a decision as part of their
campaign to introduce this as a form
of treatment. Out of this will I think
has emerged two groups: a group
that is ready. Their community is already
ready and organized to
introduce MAT into jails. That’s an easy group
for BJA to work with. We offer grants,
so they step up and write
a grant. We have a lot of funding in
this area. We currently fund 45 projects
in our traditional site site-based
grant program, primarily in jails,
some prison projects but mostly
our work is in jails. So that group
that’s already organized and ready,
they’re a pretty easy group for us. I think the challenge
and our focus right now is on the second group
that has the will but needs some
work in terms of capacity building
and building relationships with
stakeholders. So to that end we
introduced a demonstration project
this last year. We partnered with
— ventures and we put out a
solicitation that we called shorthand term for
it we called it the bridges project. What we offered was technical assistance,
intense technical assistance
for nine months. We ultimately
selected 16 communities, but we offered
intense technical assistance, including
monthly coaching, convening
for peer to peer learning exchange
twice over the course of the
project. The second one will be in January. We really wanted these 16 communities
to just have a period of time where
they focused on how do I introduce
three forms of MAT into my jail? That was a
requirement of the funding. But also how do I get this re-entry
piece right. I was a former probeation
officer, so I share the perspective
that it’s really important what
happens in jails, but it’s also really
important when you leave jails. To the point
about the rapid cycleing,
they will quickly often go into a
pretrial program, they will go into some
potentially a drug court or other court
supervision model or probeation. Getting that piece right was a major
part of the project we’re doing, the
bridges project. What have we learned
from the 16 sites so far? In fact I think
we’ve learned that the jail piece
may be the easiest part. Getting the
correctional health piece set up to
actually be able to deliver three forms
is important, but it hasn’t been the
biggest challenge for the sites. I think the
sites have mostly spoken about
the challenge about re-entry. When you’re dealing in a jail where
people are moving in and out so quickly,
how do you communicate with
all the system players and get that
person connected to a community-based
provider and also make sure that if
they’re going to any sort of criminal
justice community community-based
supervision, that they’re on board
philosophically, that they’re supportive,
that they’re not placing conditions
on them that might restrict the
continuation of their medication or impede
their ability to access medication
just through accidental
conditions. So I think that is a piece that
we see the 16 communities really
wrestling with. It’s exciting to
be a part of those discussions. I think the
second thing that has emerged
is a need for practical, tangible
products that they can pick up and
understand what to do with. So they don’t
need to be convinced this
is a good idea. The kinds of things
they’re asking for, I got a call from a
judge last week who said, “I have funding
available from a funder, but I have
two weeks to put together a budget
and I don’t know what a comprehensive
jail-based plus community
community-based project costs. Help figure
out a budget. Where do I start.”
This is a judge. Having a template
about kinds of items they should include
in a project is not something I
thought about that’s practical
and needed. Sample contracts has been
a very hot topic. Can I have a
template for my correctional health
RFP that says these are the
services that should be delivered? The same question
goes for probeation, who
is also often contracting for
these services. Some drug courts
contract for these services. What’s my template
language that I can
incorporate that insures I’ll have excellent
health care in my RFP? Data collection,
what should I be collecting to
demonstrate the outcomes I think
these sites are challengingus about
what’s the first piece I should
collect in the jail, from courts, pretrial
supervision? This has become our
focus in the next two quarters. AV and BJA and our partners in this
project are turning our attention to
really hearing from the sites and turning
around those products and getting
those out into the field so that
the sites that are just beyond them,
the others that are ready and willing
but just need resources, can take
advantage of this effort. So we’re only
halfway through this project, through
the bridges project. We do from the
institute as they’re research
researching the projects. Thank you for their partnership in
this effort. We do anticipate offering
funding at the end of the project
through the cope solicitation to the
sites that want to pursue funding. Some of them have indicated it’s not
so much of a fund funding thing. It’s really the
technical assistance they needed. We look forward to
sharing more about out outcomes
next year. With that I’ll turn it over
to Jeff.>>Thank you, Turner. Thank you for
pointing out the fact that — Tara
— the devil is really in the
details. Having actual policy changes is
the first step but then working out
the detailed protocols that the
influential people like judges
need to know. That’s really key. And next will
be Jeff. Sorry for making
fun of why you are title, long title.>>No worries. A big thank you to the
ONeill Institute and Regina, Shelley
and your team. I think the report
is fantastic. We’ll certainly do our best
to push that out to states and
governors’ offices. It’s funny when
you elect to be the lone representative
with a panel of eloquent people,
it’s quite the challenge I
have here. But I did want to acknowledge a
few people as well. Katie Green is
my counterpart. I’m with the National
Governors Association. She is here today. I want to acknowledge
two other magnificent state
leaders, Van Ingram. Kentucky, the
numbers are encouraging and Van I learn every
time I talk to him. Annie from Vermont
is pushing the field on MAT
in corrections. I’m going to talk about
that in a moment. I want to
acknowledge the great work both of them
are doing. I’ve been asked to
talk a little bit about the national
view from governors’ offices that we’ve
heard on this issue. I think some of this,
from the advocacy community I know
you want to push us to go further and
that’s your role and that’s terrific. Some of it, though,
from the state perspective is to
acknowledge where we’ve been and I think
five years ago when we started to get into
this space, when we gathered our theory
of the case is that states learn
best from other states. So we brought
eight states to Massachusetts in
2017, acknowledging at that point, early
2017, that there just wasn’t a lot
of models to look at. Massachusetts
was the longest running MAT state
albeit with one form of medication. At that juncture the conversations were
more around why providing MAT was
important inside correctional set
settings and how you can change cultures. The jump from five years ago has
been a seismic sea change both with
correctional leaders and with governors’
offices. I think it’s important
that we at least acknowledge that. I think there folks were hearing that
rode Island had been the first to jump
in the water with all three forms. The JAMA article was coming out at
that time. Additionally they were providing
— for the population they were
serving, 60 per cent of that
population were taking methadone, 39 per
cent were taking buprenorphine and
1 hers naltrexone 1 per cent naltrexone. I also want to say that Rhode
island, there are real profiles encouraged
in this country around this epidemic
and I want to acknowledge that
state leaders are part of that that. They’re not the only ones. We have federal folks here, stakeholders
and sheriffs. These are all part
of I think what will be an unwritten
story of hope hopefully success
down the line. But we weren’t done. What we said to our partners at CDC,
and I should thank them, they’re our
thought partners and supported us over
the last eight years in this epidemic,
what we said was who can we go deeper
with, with state prisons? When you look
at add mitts to the overall
justice system there’s a lot coming into
the jails, but where folks sit the most
are within state prisons. I think the
numbers are really — the data
is poor in terms of how many folks in
those state prisons have substance
use disorders? We don’t have good
data on that. What we said to
CDCDCD CDC what if we partner with a network of
correctional health leaders inside
state prisons. Dr Cat lean Mauer from
Connecticut is incredible. Bringing states
to see other states. We brought Annie from Vermont, Delaware
has all forms of MAT. But again still
correctional leaders were saying
to us those are unified systems. Is that really kind of the same as my
system with 30,000 inmates and then
we have separate jails? In Pennsylvania
we brought along as well, which
has helped crack the case of why
you can do this no matter if your state
is unified or not. With that, we
have hosted two sets of workshops. We’re going to host
an additional two next year. We’ll have brought
this at some point here I think to over
20 states I think is our goal over
the coming year. What’s most important
is what we’re seeing in terms of key
short-term strategies. I usually try to copy Tara’s talking point
points and I think some of this
is representative on the slides. Acknowledging Beth’s point about the
nationals. This is taken over
by the Nats. Bear with me. The team of the
Nass is funny to watch. It’s been exciting
to see. Similarly in
public policy. I don’t think we spend a
lot of time talking about this
nationally. We’ve stressed to state leaders
is you need the following folks at
the table to get this MAT question
right inside state prisoners. Those are the
governors’ offices, correctional
health executive, the
Medicaid folks and then you need your SSA,
the folks getting toes dollars
at the table. That is a nucleus we’re seeing
as a winning combination. I wanted top
start there and mention that. Where the money is coming from, Tara
has done incredible work in BJA. Some states are using old tobacco dollars
from 20, 30 years ago. And we’re also
seeing sizeable state investments
in this area and we predict that going
forward as well. A lot of the training
questions are the same as you’re
seeing in jails. We need protocols. We need the same
procedures that other states are using
using. We just want to
replicate them. I think that’s
where our value add is currently. Longer term, I would echo Tara’s
point around community
supervision. There’s been a big push around
the correctional space. You’re seeing
investments in supervision from
foundations in terms of let’s reform
that side of the system, but the
conversation I haven’t seen is let’s talk
about MAT and supervision in
a candid way. I think that’s what we’re
asking our governors’ offices
to do, bringing those folks to the
table early on, communities
supervision is bought in from the beginning
or at least they’re at the table
to start. A couple of challenges as well. I want to flag in the last moment
here. Ultimately the continuity of
treatment is a real problem. We’re asking
questions of where have folks on
buprenorphine, but their access in
the community is non-existent, how
can you make sure you can help with
protocols to that piece. That’s big question. Uniform screening
procedures. If you’ve been to one correction
correctional facility, you’ve
only been to one. Simplifying is that
in a way have you used heroin,
prescription drugs or misused prescription
drugs, something simple in that form. I’m not a clinician, but
that’s what we’re hearing states
are trying to do. Vermont is a great
story and hopefully Annie can talk about
this in the Q and A. You go from Vermont
to a handful of folks on medically
assisted treatment to when
they are screaming folks with simple
questions you’re getting nearly
a thousand folks enrolled until
MAT shortly. I think states are aware
of the litigation, they’re aware of the
legislation, they know they need
engaged community supervision but
they’re trying to ensure they have
buy-in both with the govern governor’s
office but with correctional leaders
as well well. I’ll stop there.>>Thanks, Jeff. That was great. I was waiting to see who would make the
first world series reference and
it was you. Go Washington state
nationals. I’m a Canadian. They used to
be the expos. I have to cheer for
them, although I’m from Toronto. [LAUGHTER] Blue jays. Toronto maple
leafs. Whoo-hoo! last but not least,
Michael White.>>I also brought
a PowerPoint. I still believe science and
data might be able to guide us
in policy. [LAUGHTER] I wanted to share some
of that with you all. We were lucky enough
three years ago to get a MAT
grant out of SAMSA, to provide MAT
connections — connections to
treatment from criminal justice touch
points. It also serveed uninsured. So non-Medicaid, non-private
insurance. That was the population we were
really going after. We’re going to
go through some of those referral sites
we’re working with to get attached
to those folks. We’re looking at
the county drug courts. We have staff
that go into the staffing with
the judge, with the clinician team,
all those folks as we’re discussing
to give realtime information to
those folks and referrals and such
of that nature. Maricopa county
jail. This is the tent city. An arbitration
happened in 2019. The basic premise
said any health care you’re
allowed to have in the community you
should be allowed to have inside jail. A champion took the opportunity to
start an opioid treatment program
within that campus of facilities. To this day all five are independently
licensed as an opioid treatment
program, so they are a wonderful partner
now under the guidance of Dr
Phillips Dr Phillips. We have staff that
go in daily. We pay a lot of
attention to pregnant women in that
facility. We can provide inductions. They have several different substance
abuse focused programs, so it’s
a really good model. I’m going offshoot
to promote naloxone. What we see
in Mike is about 9900 people
monthly with opioid history. If you don’t
think it’s an issue for criminal
justice, I would encourage you that
you’re wrong. What this is demonstrating
is an initiative by that jail complex
to put naloxone in the property
bin of those folks that reach a scale
that they’ve predetermined that’s
adequate to not go bankrupt and
provide the best service possible
to those folks. So you see about 338
doses of naloxone put inside property
bins. This is also combined with
harm reduction strategies. Syringe access
is illegal in Arizona, but that
doesn’t mean we don’t have
underground resources to that. So we do provide
that education around naloxone and
syringe access to those individuals
also. Alhambra, you have to go through
an intake, they do bio social, health
concerns. What we’re able to do
is when somebody going into prison
we do a 30-day tapeer. It’s not the
great greatest thing. It is friendlyier for corrections officer
for the patient and for everybody
involved. We hope to expand that to
a year or more of maintenance but right
now that’s where it’s at. Perryville prison
is the pregnant population. We’re supporting
about eight to ten pregnant women at any time and trying
to get as wraparound during
that process as we can. We have also
correctional health liaisons we call
them go into that facility and talk
to the ladies and they also come
into the clinic sometimes. Re-entry centers. This is a cool project that
Arizona department of corrections
has done. Somebody who has gone to prison,
been releaseed unfortunately is
struggling again is given a second
opportunity to, by their parole officer,
to do a 30, 60 or 90-day program. At that time we’ll look at this
process. At that time they’re allowed to
go to this facility and participate in
8:00 8:00 in the morning to 5:00 at
night programs on substance abuse. What we do for all
these projects is provide them
medication assisted treatment. One of the major
things we do for these projects and I
put this model up so we can have a guide,
is that a parole officer or a warden
of this facility can call us up, say
I got jimmy Joe down here, he’s
withdrawing, we’d like to get him assessed
for medication assisted treatment. We bring him in, because you have
to do face to face for methadone. They come over that day, we do the the
the induction. They never have
to come out again. What we do at that
point is get a federal exception
for take take-home medication for
that specific medication and
then we do any medication
adjustments via telehealth. We then have a
nurse deliver the medication to the
facility so that person can
participate in their 90-day programmer
without any security threat to that
facility facility, if that makes sense. So we’re going
to look at data, outcomes
from what most people would consider
high-risk populations and then
providing them medication assisted
treatment. I skipped it, but
the sample size is 252. So the majority
is utilizing methadone. There’s another chunk utilizing
buprenorphine. A small population, reflects
closely to Rhode just a little
more methadone. We’re looking at
demographics here. What’s interesting
is the 32 per cent post-education. That always — and age group. I’m going to
fly through these because
we only have ten minutes. We’re doing
a brain dump here. Sorry, I skipped
ahead preponderates
and ethnicity. We noticed a 33 per
cent reduction in arrest. This is third-party
data. They’re fantastic. Then a third-party data collection
named Wellington helped us out
with this data. It’s pretty reliable. Then we saw a 38 per cent reduction
in drug arrests. We saw a 57 per cent
reduction in crimes committed, 57 per
cent reduction nights spent
in jail. Drug court, the
accountability measure for
missing and IOP, intensive
outpatient counseling group or a meeting
with your probation officer is a night
in jail, so there should be an asterisk
there. If we can pull that
information out of there, that number
I believe would be much higher. We do have
a a follow-up rate of 75.25. That’s the thing I’m most proud of. My staff really did some good work to
get that rate. I don’t recommend
sharing this slide with everybody,
because it can be misinterpreted. However, what it does is demonstrate active
days of use from a harm reduction
model, this is forminal. From a criminal
justice viewpoint that you
has done a war on drugs for the last
little while, this can be mis
misinterpreted. So hopefully you all
have access to these slides and can
utilize them if you need to. Then I love
the comment earlier about social
determineants of health. I’m right there. And so I always see it as
you mean the things that we should have
always done and now we have this
fancy word for it so everybody wants
to say it. She said it much more
eloquently than I ever could. We noticed
a 28 per cent reduction in
unemployment, an 85 per cent increase
in employment. I just want that to settle
in real quick. And then a 43 per
cent increase in permanent housing. So with this model, we really did
a lot of work in 2015. However, we’ve
leveraged this model — I work in
nine states, so I try to leverage this
model everywhere I go. So successfully
we’ve leveraged this model. North Dakota is phenomenal. For the department of rehabilitation,
the doctors are phenomenal. They’re doing
three years of maintenance for
any three of the medications because
they know 90 per cent of their
population will serve 32 months or less. They’re basically understanding they’re
going to get their entire opiate
use population population. A phenomenal group. Alaska brings up a
point that a lot of these programs and
projects exist because somebody
passed away. Somebody got —
sorry, I can’t help but to Cuss. They got screwed
over. Somebody’s family
member got hurt, a baby died, these
other things, and a lot of these
correctional programs exist because
of that. I don’t think we need to wait for
these things to happen to implement
them. But then just moving on. Sorry, I’m going to get emotional
on everybody. Montana jails DOC has a
planning grant should be up and running. Wisconsin we just got a BJA grant,
implementing in a few months. Again, North Dakota. You think these small
jails that may only serve 37 people
annually, but you should still do it. A lot of people say corrections needs
to change the way they view it. Opiate treatment
programs need to change the way they see it too. If you’re
prescribeing a medication to
somebody and the jail is going to let you
in, you need to figure out how to
provide that service to someone even
if you get paid or not. It’s your eth ethical
obligation, in my viewpoint, to be
able to do that. So I just want to
make that point, that it’s both sides that
need to change the way they think,
not just one. Alaska department
of corrections. If you haven’t heard the
story of Kelsey Green, I’d encourage
you to look it up. It is the story
of the opioid epidemic, by
all means. Milwaukee, we got the BJA grant,
up and running in a few months. We thank BJ
for that. I wanted to provide
these links if you haven’t seen them,
they’re helpful. It’s been mentioned
many times. We definitely see this
encouragement from those agencies to
be pushing forward on this. It’s been a great
help from my viewpoint, where
I have to be this corrections
corrections whits perrer around diversion
and things that get worrisome for
that group. So that’s it.>>Thank you, Michael. That was wonderful. You know you
have a great panel when they all
follow the time limits and get key
points across in good time. I really appreciate
that. In listening to all
the speakers talk about their areas
of expertise, there are certain recurring
themes that come up. One of them I heard
certainly was this idea I didn’t
know before, but I know it now, this
idea of stigma, lack of education,
awareness, amongst all of us and amongst
our constituents, our communities. There was something you mentioned,
sheriff, talking about the incredible
results in Albany county, with the
help of Oasis and local and state
government. You had mentioned that when
it came to — you were using naltrexone
injectable injectable, known
as Vivitrol there were some results
but not really and you approved all
three of the FDA approved medications,
it sounds like. By the way,
everything I talk about in these talks I make
clear, everything I’ve been talking
about has been from on the job training. That’s why I made a specific point
to the medical students from
Georgetown that were speaking
speaking, I wish I had that level of
training and understanding of addiction as a
chronic health issue when I was early on. But you learn and I feel a
responsibility to share what I learn
with everyone. I’m grateful to
all of you. Sheriff, you said you were against
it at first and you cited the example
of Suboxone was smuggled in. I have to tell
you when I was working at
the island, one of the trainings I gave
to the wardens and all of the
officers inner leadership down from
there was that buprenorphine
actually works and saves lives, and the warden
right away, one of the wardens said:
Whoa!, I’ve been telling my office
it’s contraband. I’m like I know,
our solution to it was the diversion
program was to say prescribe it more
wide widely. What helped you with
that shift in perspective
perspective?>>Mainly the 20,000 emails I got
from Keith Brown in Albany. [LAUGHTER] I’d wake up, I’d
have Keith Brown emails.>>Twitter hashtag
addiction policy. Keith. Brown, tweet Keith.>>Listen torques
digress really quick, back in the
80s and 1990s we tried to arrest
our way out of it. That was the
methodology here too. Throw them in jail. Albany county is a thousand
people jail. I thought the Vivitrol would be
the next best thing. The first shot
was free by the pharmaceutical
company, obviously self- self-serving,
but they will be out and be clean and
hopefully stay on it. I started to look
at some of the evidence-based data. I think I’m doing this wrongp
I need to open this up. By prescribeing
it you’re serving and saving dozens. We started with a three phase. Phase 1 took off. We were like wow
we’re burning up funding. That’s something
that kind of irritates me as
well and you can hear it in almost
everybody that speaks. We have to look
at funding and the data and
everything else. I look at a different
format of these are human freaking
lives and we need to do everything we
can as government officials to
save them. We’ll figure it out. But if you look
at keeping people from going
back to jail and recidivism rate is
going down, you’re serving less
meals, less pharmaceuticals out
of your medical. Your tiers are
closing down. You can save a lot of money. That’s how we’ve done it with the
assistance of Oaasis. Let’s save the lives
and figure it out later. That’s the format
we took.>>By the way, Michael
and folks know that our panel is
also being swear friendly, like the
fireside chat. Hey, man. Say whatever
you want. I don’t care at all. The poignant conversation of the
fireside chat with Michael, Tracie and
the mayor, it’s about priorities. This idea of oh, we don’t have funding
and this idea of — you’re going to
get push-back. I’m sure all of you have
faced push-back in your jobs, we
don’t have this, that, resources,
operationally, it’s not going to
be possible. It’s about priorities. It’s taxpayers’
dollars, right? Oasis as a state
agency is funnelling taxpayers’
dollars and understanding what’s
important. It’s lives. It’s livelyihood. Thank you for sharing that. Beth, you were also talking about when
— through Pew doing the trainings. You discovered really this pervasive
stigma amongst staff. I will say what
I noticed, what I experienceed
working at New York City jails
is that when I approached the chief
of corrections, who at the time,
chief Murphy, intimidating-looking
guy, so when I approached him in
his office he was sitting behind his
desk and I said: Chief Murphy,
in my new role as addiction medicine
director, I’d like to provide training,
addiction 101, which I’m providing
to the medical staff, because huge
gaps in knowledge amongst the doctors
and nurses, but also to our IT and
HR, but I’d also like to offer it
to your corrections officers, who are
really first line. The first thing he
said to me, humbly, almost hunched over,
said: Whatever you have to offer,
we’d love to learn. Back to Mayor
Williams, and what Tracie was saying
too, he was saying no, it’s the
community. But you have to have leadership,
acknowledging their gaps in
knowledge and what needs to be done. I’m curious,
Beth, you said — you started
with education of staff. What are some
of the things you heard from the
staff in terms of maybe some
stigmatizing attitudes and how did you address
those?>>The program really was
cultivated through the New Jersey dement
of corrections. So the leadership
there, the commissioner of
corrections really acknowledged that
the state prison staff needed to
be educated. I think what was surprising
to them was that the clinical staff
needed the staff. They took it as
a surprise in our conversations. They thought perhaps
the clinical staff would recognize and
understand the disease of addiction
addiction, but it didn’t seem to be true. We also heard about push-back from the
protectional health staff about their
own biases around medications for
addiction treatment. So this was
something that surprised. So in their head the
idea is we should work with all the
corrections staff but then also
realizeing now that they had to then
develop a curriculum to work with the
clinical staff. It’s been very fruitful
for them. The attitudes have
changed across the system. One thing they
do point out, it was important for
them to use peer corrections, folks
not to have some outside outsider
come in, but to actually have someone
within the system or someone
who understood the system, knows the
system, to provide the training
to them. It was much better received
and they’ve seen success moving
forward. This is something we will
emulate with the counties.>>That’s great. And by the way, encourage all
of the panelists to jump in whenever
there’s something you want to talk about. We want to make sure we leave time
for questions and comments. I often find the most engaging part of
at least the talks that I give is really
the comments from the audience,
whether you agree or disagree, we want
to hear from you. Tara, I really —
I think the bridges projects has been
really remarkable, providing technical
assistance. I assume part of that
is education and implementation
of programs. You also mentioned
the work and you recognize the work of the
national sheriffs association and
their adoption and implementation of
MAT medications. Can you clarify:
Do they utilize and implement all three
forms, including methadone,
buprenorphine, or is it still mostly
naltrexone?>>I want to acknowledge the
national sheriffs association as well
as ACA that Jeff mentioned earlier
and the major county sheriffs. I have found
all of the associations to
be talking fairly openly about all
three forms and the data surrounding
all three forms. So I think they’ve done
a remarkable job of presenting the
options and the benefits. May I take your
invitation to chime in
on one thing? When you don’t use PowerPoint
you forget one of our points, of what
we’re learning out of our sites that
I want to pig’back on the question
of stigma. One of the things
we’re learning from our site is the stigma among peer
recovery coaches and a lot of jails
are introducing peer recovery
coaching into jails. It’s also being
introduced in probation and other
criminal justice justice-based
programs, drug courts. But one of the
things we’re hearing from the sites is
that there’s some stigma against MAT
in that community. So it’s interesting
what you learn when you have a
cohort of sites teaching you things. I think there’s space
to really do outreach to that group as well.>>Thanks for adding that. I am still —
I work in the addiction space
and have been for several years now
now, and I still do most of my education
amongst my colleagues in the
addiction space. I try not to do so
in a hierarchical kind of way. I just say:
Hey, I never learned this in my
training, but now that I know it. In fact I want to
quote something one of my colleagues in
this space I’ve heard him say in his talks
and you’ll hear from him this afternoon. Sometimes it’s harder
to unlearn what you’ve already
learned. Now that I know these medications are
life-saving, methadone,
buprenorphine, naltrexone, they’re life-saving. I also learned that some of the
words and phrases I used to use were
harmful, and folks like Mr Michael
Botticelli and other folks like Sarah
wakeman and riches Rich and John Kelly,
words matter., especially in the
addiction field. So when we use phrases
like substance abuseer, drug abuse,
it actually has harm to patients. They are less likely to seek care,
more likely to per receive
discrimination and health care professionals
spend less time in clinic and label
people with addiction as unmotivated,
manipulative, angry. All thattades up
to sub-on the mat care. sub- all that
adds up to suboptimal care. I’m a type A physician. Nothing happens fast enough. Yeah, thank you. You talked about —
first of all, I thank you so much for
talking about the different states,
Massachusetts, road island, Connecticut. I have to tell you, people like Dr Jody
rich, Jennifer Clark and Kate are
heroes of mine and mentors and
colleagues in this space, integrating
medicine, evidence-based medicine in the
correctional space, which is challenging,
but they’re really doing it. But they’re creating a model of what
can happen. Three different states with
three different kinds of models. You talked a little bit about the ACA
and sometimes this push-back of oh,
well those are unified correctional
settings. I’m curious how you’ve
been addressing that kind of
push-back and resistance in terms of charging
forward.>>And again I would
encourage others in the room who are state
leaders to chime in on that conversation
as well. What we’ve seen is that
the seeing is believing. If they’re able
to see the systems, what they’re
doing, that’s I think pushing the
conversation forward. So seeing what
Pennsylvania and the secretary of
corrections, the governor’s office,
their ability to push through a system
that I think has over 40,000 folks
with different pilotsw all three
forms of MAT, I think that’s a really
good — that answers that
question, can this be done outside of you
know form uniform systems. As we move forward, something for both
jails and prisons to be thinking about,
Tara thinks about this, I’m sure
the sheriff does as well, and Pew
but what’s the kind of evaluation that
we’re looking for in this space
and what are the partnerships we want
to be pushing? I think we’re seeing
state systems look to state university
systems. So who can be partnering
with them to track this over time so
we don’t have to keep making the ROI
discussion five years from now and
we can be pushing forward. I know states
have a role to play in that
discussion as well. I want to put
out this idea of evaluation. It’s not just
recidivism. What are the other
things we want to be evaluateing
as well. I wanted to add that as well.>>Jeff makes a great point. One thing
we hear from other states is that
what are other states doing and
what is their data, outcomes. Really getting
states to gather this data. We know it’s hard because it takes —
sometimes it takes money. But there also
has to be an emphasis and
understanding that the data you collect
and the evaluations you can put forward
will really drive this home, especially
in converting other states, showing
them they’re actually is an
opportunity for them to do something in
a good space. So really getting states
to share their data with everybody
else is so important.>>Absolutely. Who was it? It was Jeff who said
states learn best from other states. I think that was a great line. Before we move on to Michael, I encourage
all of you to formulate any
questions or comments that you have and use
the microphones. I want to say there’s
a very common saying in the
addiction space, I think many of you have
heard it, the opposite of addiction
isn’t sobriety but connection. A lot of the work you’re doing with
community services highlights the
importance of that connection. It’s not only
between the patient or the
individual experienceing
addiction to connecting him or her to their
families, to health care system,
to support services, but it’s
also connecting one another to the
different conversations so we’re not, as
Michael said earlier, practicing in silos,
but we’re talking to one another
and learning and filling each other’s
gaps in knowledge knowledge. I’m so glad that you talked about the
access for — the pregnant women who
are behind bars and getting these
women access. Can you clarify what
medications they’re receiving, and are
they receiving the medications and
access to services after delivery?>>Yeah. The majority of the time they’re
receiving methadone, sometimes Subutex,
a buprenorphine product. It depends on
the state or institution. Most of the
time it is methadone. I’d like to
share a story to highlight
that point. Back in the early days, 2015t
I was in drug court and a young lady
gets A listed which means she did
everything she was supposed to and
compliant, you’re in analysis and all
these other things. Commissioner White
at the time standing applause,
she gets to get out of court early,
which is the best gift. You don’t have
to sit there for three hours. On her way
out she said I have a dependency
court case this afternoon. Would you
go with me? An hour later we’re
eight miles away in a different courthouse
for dependency court. If you don’t know
that, she’s being judged whether
she can be a parent for
her child. So the court doesn’t even
necessarily start and a judge says I am
moving to sever the rights of your child
today because you continue to be on
methadone and it was over. She still does
not have her child. So what was
interesting, July of 2015, I kind of
went back and I was thoroughly upset. I’m very calm right now, but I
was upset. And so I did some back research
and come to find out this young
lady, she’s in a residential, they
would have supported her and her child,
she was a combat vet, tied in with
the VA VA, she had a drug court team, so
PO, judge, all the things that come
along with that. She had a department
of child safety or a CPS team, so all the
things that are associated with that. None of our systems
were talking together. We were all probably
just traumatizing her day and day again
by bringing up the same questions
and having her do the same things. She’s with two urinal cisproviders. The difficulty we made this young
lady’s life and she never really
complained about it. She just did what she
was supposed to do. To this day she
still does not have her child. I mention all these programs and it
goes back to the point, most of the
projects exist because of some
sacrificial lamb, just somebody lost
something big to have them up and running
running. So what’s interesting
about that is it caused this step to
action, this call to action. We got what
the director of DCS, we’ve done
hundreds upon hundreds of trainings
to that system, and we’ve put a
big focus on the attachment of that. So the pregnant ladies we have a
definite focus on when they’re
coming out of corrections. We’re even looking at infant care plans
for pre-dependency court hearings so
getting them in the court process
and beating the investigateors
to it before the hospital. Our ladies show
up to the hospital with a
booklet in their hand that has the urinal
cis, we do parenting classes
before the baby comes because that
makes sense instead of after baby comes. All these pre-emptive things. When the department of child
safety worker comes into that
hospital, they Salem enjoy the birth of
my child, take this book. It has all the
information. Let me me en enjoy my
time right now. That’s what
we’re doing.>>Thanks, Michael. Thank you for
sharing that story. There’s a common
saying that — and I firmly
believe in this: The only way to move
the needle forward when it comes to
not just the opioid crisis but addiction
in general is through science
and storytelling. You’ve already heard
several people this morning alone
that are excellent storytellers and they
know their data. Michael, Tracie,
mayor Steve, they know the science but
they have so many personal stories
stories. But sharing stories like that
is a reminder that it’s not just
about data. Even though we’re really
pro-data. But Beth, you gave this great
image about the 47,000, but sometimes
numbers are just over overwhelming. What’s 5,000, 5 million? But I can picture the stadium and how every
single one of them are dead. So it’s stories. When you bring it
down to the individual, and the fact that
addiction really is a medical,
psychological, social problem that impacts
adversely every aspect of society. Are there any questions, comments
right now?>>I’m with the health and
justice action lab at northeastern
university. I work with Leo. I wanted to thank
everybody for this great panel
and this whole event is great. I want to — a quick comment to support
what you’re saying about language
and narrative narrative. As a resource
for people to use if you
want want. Because often the concern
about what language not to use but
then you’re left wondering what is
good language to use. We should do person
first, then language. We’re leading
an initiative to provide some of
the language you might need. The website
to check out is called changing
the We’re trying to
help change this narrative for a
better narr narrative. Check it out. Changing the and you can find plenty
of language to be helpful. Thank you.>>Thank you. Thanks for setting
Leo at another impactful person in
this space from a legal and policy
specify. Go ahead.>>Van Ingram Kentucky
director of policy. I think this
question is probably for
Michael. We’ve had a naltrexone program
at our prison for a number of years. We’re in the implementation
phase of adding buprenorphine. The one we’re struggling with
is methadone. We have about 26 locations
that are either medication centers
or full-blown methadone clinics. We overlay them on a map we have desert
areas will people would need to drive
an hour, hour and a half every
day to dose. We’re struggling with is
that unethical to put someone on
methadone when you know when they go home
it won’t be easily available to them. You work in rural states. Is that an issue
where you come from him him?>>I have that same
ethical debate with myself. Sometimes it can
be accomplished. You said Kentucky? I apologize.>>Yes.>>So we stole an idea from
you all I think in Med units,
so being able to establish them
closer to to corrections and being
able to serve more rural
communities. We’ve done some of that in
Arizona and looking at North Dakota and
Montana and some of those things. You’re absolutely right. When — we’ve
had people move to to a city, because
the other medications they’ve
tried and didn’t work. So sometimes it’s
relocation, unfortunately. But I constantly have this discussion
in particular with Montana just because
it’s so spatial. So in my view,
buprenorphine is probably the more
ethical choice. But that’s just personal
opinion. But there’s a lot of
— I always want to say there’s a hundred
different solutions to
a problem.>>Michael, is that your choice? When you say eth ethical choice,
is that because of logistically
it’s just more challenging for
the methadone.>>I mean in every state
I work, we have people driving two,
three hours, we sometimes have people
driving from South Dakota to
North Dakota. And so transportation is
a huge barrier for our folks.>>I’m looking
at Michael. Massachusetts is
one of the states, I lived there for
several years, very pro-with evidence
and science. Michael wouldn’t
you say access to methadone isn’t
widely accessible in the entire state? It’s difficult.>>But we need
to change that [APPLAUSE]>>100 per cent. So it’s moments like this
when I really, really miss Dr
Robert Newman. Bob Newman was such an
advocate for this medication, which
is really life-saving. The reason why most people in this
country don’t have access to it, it’s
a regulatory issue, it really is. This is a medication that works. If you look
at countries like Canada,
Portugal, any doctor can prescribe it. Every pharmacy
dispense it in Portugal,
widely accessible. They have vans
distributing this medication. Again, I think the push-back and
the logistical challenges that I
know you’re going to hear from, from
sheriffs and other leadership. But I also
don’t blame them, because when
you discharge patients, where will
you send them to? Telemedicine is
possibly one solution.>>National alliance
for medication assisted recovery. I wanted to follow up with Van’s and
Michael Michael’s comment. Last month some Yale researchers published
a letter where they had a study
of five appear laborrian states,
including Kentucky, Ohio, West Virginia
and they looked at access to dialysis,
qualified health centers and opioid
treatment. And of course they found
that the amount of time it takes for
an individual to go to dialysis or a
primary care center was considerably less
than it was for addiction treatment. Their proposal was to expand access
through primary care, qualified
health centers, et cetera. I just wondered
what your reaction might
be to that.>>Thank you.>>I’ve helped several
agencies walk down the road
of implementing medication assisted
treatment into their agencies. So, again, regulations in place
and just the amount of work it
takes to right now get something up
and running is very difficult. I think everybody
has the idea of doing it. But once they start walking down that
path it becomes very difficult with
all the licensure regulations. I absolutely
agree that things need to change
and make it more available. I think Med
units and some of these other
things are possibilities within
the restrictions and guidelines that
currently exist to expand. But, yeah, I
would love to see what we’ve
discussed earlier.>>If this was a
leukemia epidemic, would we make
patients drive three hours to get chemo? I know there are some patients that
do that, but it’s not the norm. We have a system that we’re setting people
up to fail.>>Hi. Anna Black from
department of corrections. We relate to the game but we’re
implementing MAT in four of our facilities and
one coming up next month. As we’ve done
a lot of work on the opioid use
disorder use issue with staff training,
with the language, what lessons you all
have learned that we can use to ready
for the next wave of public health
issues that will be seen inside our
systems, maybe with the stimulants that
are coming next and other public
health issues? How can we use what we’re
learning with implementation
of MAT to ready ourselves for
what’s next?>>I think you hit the nail on
the head when you talk about
education. Because we know that psycho
stimulants are making a resurgence. They’re also being coupled with
opioids. This is something we’re
seeing now, hearing from a lot
of states. So making education part of
something that’s part and parcel
of the work flow within any type of
agency including a correctional system
so it doesn’t become this one-off
thing that I have to learn that I’m
constantly being educated on HIV
HIV, Hep C, psycho stimulants and opioid
use disorder and substance use
disorder.>>I’d love to follow up on that. We just hosted a methadone policy
symposium in June. Then to a talk a couple
of weeks ago about how can we expand
and use those models for other substances
and behavioral health issues. I want to share with you our brief model
and what you are seeing. I think the
basic problem with re-entry is
it’s easier to get heroin and fentanyl
than these medications, economic
decisions we’re making as a society. So what we’ve started doing is
providing the same day access to
medications, syringe exchanges, home
homeless shelters and no appointment, drop
in, substance use is fine initially
and ongoing because most people use
multiple substances and they will stay
on Suboxone and opioid use and
mortality will go down. Part of that is
staffing that with nurse care managers,
whatever you want to call them, but
I think that type of care team, staffing
model and general approach which
expands from whether you want to
call it harm reduction or person
centered public health care, I don’t care. It’s all the
same stuff and we want
customers, right? We need to build systems that
want customers. Right now you think
we would not want customers coming
in and getting our services. Flipping that
around, flip that narrative. If you’re doing that, if you’re giving
people added value they’re going
to come. When we first build a buprenorphine
program, within a couple of weeks
we had people lining up two hours early
to get treatment medications. That’s a problem, but it’s a great problem
to have. I think it’s important
for enabling our corrections systems
to actually get people started
on medications. It also enables primary
care providers to stop complaining
about how hard it is to induce patients
because it’s not. If we need somebody
else to do it for them, we’ll do
it for them. We need toe create a real
continuum for everything.>>Thank you. Any comments from
the panel? [APPLAUSE]>>I think you would
have seen a lot of heads nodding
at you on that. Re-entry systems
look different across the United States. I think to Van’s points, Kentucky
looks different than parts of Washington,
but other parts of Washington do
look like Kentucky. The other question
we grapple with from the governors’
association when we look at our
corrections agencies is where budgeting is
going with respect to re-entry. When are you going to prioritize re-entry? I think you’ve seen states elevate
the budgets for re-entry offices
to be trying to map and think
strategically to solve some of the problems
Van is raising and you’re articulating. Then it’s elevating those
models and trying to get them replicated
to the extent they can.>>I want to
follow up on something Beth said,
also a follow-up from the earlier
fireside chat about right now the drug
we’re talking about is the class is
opioids, but there’s always going to
be something. There always was. It was cocaine in the 80s, heroin centuries
ago and morphine. There’s always
going to be something. It’s not that psycho stimulants are
increasing. In some states that’s the
leading drug, actually. Just addressing
some of these racially
driven policies. We just need to address
this as a health concern that impacts
every aspect of society. Let’s get people
the care they need and deserve
and create systems so that it’s
just chronically accessible
accessible, so that we don’t have to
readjust every time for every single drug
and substance.>>Hi. I just wanted
to introduce myself. I am the Annie
from Vermont. [LAUGHTER] So thank
you, Jeff, and thank you, panel. I’m in the house. I’m also available
all day for anybody to come and pick
my brain and to add to the discussion. I’ve been at this for a long time. The department has
been engaged in providing MAT in the correctional system
since 2013 and I’ve been on
that ride. It’s been an exciting journey. Secondly, I’d like to make a plug
for internal partnerships,
internal state partnerships. We have a strong collaboration with
our Medicaid agency, which is
called the department of Vermont health
access. They are helping to provide
added evaluation and care coordi
coordination and really a longitudinal
survivor study in the state of
Vermont ongoing. This is providing a new,
exciting template for all chronic
illness care management. Not only is the data collection going
to be incredibly powerful and helpful
in helping us sustain this effort
and prove this investment is worth
— more than worthwhile, but we’ll
also be adding ago fourth layer
tore that effort in that we will
hopefully very soon having inmates sign
additional waivers so that upon release
and even prerelease we will
have chronic care initiative care
managers who are are part of the Medicaid
system reaching out to them, in
addition to probation officers, everybody
else who cares. We have an extensive
peer support system as well,
recovery oriented and into release. But these care coordinators will
also be providing them constant care
and we’ll be mining the gaps in treatment
when they fall off. Lastly, Van hi. Nice to see you. For those of
you who are Medicaid expansion
states, there are a lot of hidden costs. The hidden cost of transportation
is obviously critical. The state of
Vermont, for nonemergency medical
transports, spends 16 to $18
million a year simply getting people
to treatment. So I am definitely going
to be beating that drum, because that’s
an added cost. Thank God it doesn’t
come out of my budget, but it needs
to come out of somebody’s budget
because it cannot be borne on the backs
of our citizens who are simply trying
to access their human right to
health care.>>Thank you, Annie, from
Vermont, yet another state — Dr John
Brooklyn, yet another individual I
contact all the time, just like I contact
my former colleagues
in Boston. These are people — I encourage
all of you to really get to
know your fellow attendees, not just
the people on the stage, because there
are so many of you that are doing
great work. Please talk to
one another. Any other comments from
the panel?>>Good morning. Jeff. For my sins, I recently retired
after 30 years as a federal drug policy
person, the last 15 of which
were at Nita. Two quick things. I wanted to double
or triple down on the — today
it’s opioids. It’s not just
opioids today. CDC just releaseed its data. 19 states west of the Mississippi. Yes, they have opioid problems. The number one drug associated with
overdose deaths is methadone today. Not yesterday, not tomorrow, but
right now. So we all owe it to ourselves
and to the country to be beating that
drum every day, not because we shouldn’t
perhaps be using the rhetoric around
the opioid crisis as the tip of
the spear. That’s perhaps what
gets us in the room or in the discussion,
but we’re doing a disservice to the
country, to our parents, to families
all across the country by not
saying that. The other thing I wanted to
mention is that the criminalization of
addiction for the last pick a number,
any number of years, I’ll say 50,
because why not, means that some of
you are at the table. This is a really
important panel panel. You’re doing
God’s work. People like me,
who spent — I actually started my
federal career at the national
institute of justice. I don’t have anything
personal against the justice and the
corrections system system. Quite the contrary. I don’t think you
should the ones at the table, in theory. Today, you should be
because that’s our system and you have to deal with
what you have and listen until
you change it. But for many policy folks,
for many folks who have worked not
just in the health system but especially
in the health system, for the most
part, we don’t want to have to
talk with you. We don’t think that
you should, for the most part, not
entirely, but for the most part, have
to be dealing with this. It’s unrealistic to
suggest that you shouldn’t, because
addiction is everywhere, has
been, will be. But for the enforcement
community generally to have
to have a leading role here, for many
of us, is — I also won’t be profane
— is backwards. Michael, for years
I tortured you by saying — you and
others — for all of us who said or used
to say we can’t arrest our way out
of the problem, speaking personally,
that’s part of the problem. That’s part of the societal
stigmatization of addiction and of people who
use drugs, frankly, whether they’re
addicted or not not, that we have all
thought about this health issue not
somehow rhetorically as a health issue. That’s not really a question. It’s pore of
my opinion and thank you for
letting me say that. MANDY HARVEY:
Thank you, Van. It was Jeff who said
states learn best from other states. I think countries also really should
learn best from other countries. There’s so much that this country has
to say offer the world, but there
are things we can also learn from other
nation-states. I think of my own
home country Canada, but I also think of
Portugal, which de decriminalized all
drugs in 2001. When I met with
their national drug policy leader, as
well as their other policy-makers, they
will tell you, yeah, de
decriminalization was a part of it, but really
they took a public health approach, from
every minister, from the ministry
of justice and health and social
services, they all came together and
decided we need to work on this. Was it you, Jeff or Michael? One of you said
— sorry. I may not be giving
proper credit, but somebody said that
— I hate to say it, but the right
person kind of has to die, the right
people have to die die. In Portugal, the
daughter of the minister of justice
died from a heroin overdose, and when
that happened, he made sure every
jail and prison in Portugal provided
every medication, methadone,
buprenorphine. I hate to say that it’s a more
bid take take, but it’s reality
too. Let’s hope we don’t get there. Ting for time purposes we’ll have
a last question.>>I just wanted
to not push back. Was it Jeff? I take your
point from the justice field
that public health didn’t want to kind
of see this — cede this. Quite rightly,
but is it productive at
this stage to be thinking about that? I think where we’re at now is
perhaps there were too many years of
not talking to each other and being
really good at siloing within our respective
fields, within levels of government
that I think frankly at this
point we’ve exacerbated and
now have to overcorrect and
go back and create those partnerships. I take your point about this is
a public health approach, it should
be public health leading, but I think
we got really, really good at not
talking to each other for a long
time, before my career started
started. That’s also important to think
about as well.>>I agree. Last question
and then we’ll have conversations
after.>>Family physician, consultant
for the Baltimore county
headlight department where we’re putting
medication assisted therapy
in the Baltimore county jail for
the first time. There are other
jurisdictions in Maryland. We got the grant
basically and all these public health
people get invited to the party. We’ll show up at any party where you’ve
got money. Which is how I think about
the corrections public health dynamic
dynamic. What I get a little
interested in, I get invited to lots
of meetings and we have great
conversations about opioids, and I
don’t always know what question we’re
answering but the answer is always
money, what it boils down to. I think we
can all agree based on the
conversations earlier today there’s
plenty of money to go around, it’s in
the wrong places. Have any of you seen
people directing this problem
head on? We’re going to spend money and
do good with it in public health, but
if I was a hospital director or if I’m
responsible for Medicaid spending,
the transportation said, the housing
authority, probably — the problem of
drug addiction in my community is
expensive ome and if we’re doing this
hard work in the jails and all these
people are living and thriving, putting
their lives together, how do
we get some of that savings back. The pocket problem is pervasive. Here’s all
the money you need, medical
treatment, prisoners are the only people in
the United States with constitutionally
protected right to medical
treatment. We can work with that, but in
the very long period of time before that
actually becomes a reality, I’m worried
about the wrong pocket kind of
problem and to get — who is getting the
money that’s being saved by all of our
hard work within using that to build
sustainable funding sources until
that will day comes. Over.>>Who wants to address that.>>Almost every savings
in government goes to a sex
sexy project. Addiction is not a sexy
project. We tried innovative ideas. As talked about early on about our
re-entry program, if they don’t have
a place to stay, we turned a wing
in our jail. We got them set up so we
can get them back into society, show
you how to set up a bank account. We’re working with
local hospitals to take some of the
homeless that are going into the
hospitals, tying up beds, nurses, doctors
for really issues that can be taken telemedicine,
whatever the case may be. Millions and
millions. I think once we can
do some quantitative analytics on it we’ll
save millions of doctors in ERs by
taking the homeless, letting us work
with them. Hopefully in the morning
they will accept addiction counseling,
job training, whatever the
case may be. But we’ll never see any
of that money. Usually in government it goes
towards another sexy idea, a rail
trail, a walkway, a beautiful thing
named after a park bench, whatever
the case may be. [LAUGHTER] This is
what we fight with all the time time. The problem with
having an innovative idea is usually you
miss the funding. You get out, you find
a way to fund it, get out there and do it,
no offence, BJ will come up and say we
have $2 million, we’ll roll it
to this county. Hey, wait a minute. We can use just a little help here. So it’s a mess. Hopefully through
the savings anyway that you’ll be able
to roll it back into the people that
really need it and that’s something
that we push for in Albany all
the time.>>Telemedicine,
plug for that.>>Yes, we need need
to really roll out telemedicine
in a big way.>>I want to answer
your question without actually
answering your question, because I’m
pretty good at that. [LAUGHTER] It
doesn’t cost money to make a phone call. It doesn’t cost money to bring in
a collective impact model. If I’m doing opioid
treatment programs but I know
some of my people need family services,
I need a family services provider
at the table. Where it gets
complicated for corrections is that you cannot get
reimburseed from an agency to go in
and provide that work. Agencies need to
step in and go in and provide
that work anyway, especially 30 days
prerelease or some kind of boundary
that they’re comfortable with. But the community needs to get on
board and support corrections too. But a lot of this work, the mayor
mentioned earlier he reallocated time
of his existing staff. All those things,
there are a million solutions
out there and you don’t always
need money. That’s my stance.>>On that lovely
note, thank you. I want to thank
the panelists and thank all of
you for attending. Thank you. [APPLAUSE]>>Thanks so much to
our great panel. That was a really
wonderful discussion. A couple of things
before we break for lunch and further
work. The first is that I wanted to
make sure that everyone has a copy
of our report that has been releaseed
this week. This really delves
into a lot more information. It provides what Lipi said so eloquently,
science and storytelling. Because I’m
a lawyer, I sometimes think you
need the law to get people’s
attention. Because nothing like a
lawsuit to draw attention to
something. [LAUGHTER] So we talk about
that in here. And also, as I was thinking
about this panel, I also think this is
beyond the scope of today’s discussion,
but at the same time, there’s a
lot of discussion going on about
criminal justice reform, so we keep
people from being sentenced. What we’re
talking about today is those
individuals who are incarcerated, who
are going through the nation’s jails
as an intervention point. Arnold ventures,
we have Julie here from Arnold
ventures who can probably talk about
the work they’re doing on criminal
justice reform as well as justice
reinvestment and the purpose of justice
reinvestment is to get those dollars
put back into the right pockets. So it’s not a perfect system, but that’s
something that I’m sure you can all
talk about. I think it’s great that folks
are introducing themselves at the
lunch break. You will pick up your
lunch in the Fisher colloquium, that
big room near where you registered,
and the coffee was serveed. Three of the
panels will be in that room. One of the panels
will be on legislative action to
drive change, where we’ll be talking about federal and state
policies, and I want to talk about
methadone vans for anyone who will
listen to me once again. We’ll also talk
about best practices and
models for operationalizing
reforms. That will be led by two of
our colleagues from oasis in New York. The intervention from a couple of
folks from the ONeill Institute. So everyone
will get their lunch and take a
couple of minutes. So we’ll start those
breakouts around 12:15. Then we’ll —
that will go until about 1:30. So you’ll have lots of time for
opportunities to get into in-depth
conversations, which is what we wanted
from today. Then also the other breakout we’re
having is on legal landscape
and litigation. That will be in Hariri 415. So if you are facing Fisher
Colloquium, that big room, it’s to
the right. You have to walk down a walkway
to the right. We’ll have signs
for that that. Pick up your lunches in
Fisher Colloquium, we’ll have the
breakout areas, and Hariri 415 is to
talk about legal landscape and
litigation and we’ll be back here at 1:30. Thank you very much. [APPLAUSE]

1 thought on “Applying the Evidence: Morning Sessions

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